Senior Pharmacy Clearance Operations Manager

5 days ago

Norcross, Georgia, United States Soleo Health Inc Full time

About Soleo Health Inc

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Soleo Health Inc is a leading national provider of complex specialty pharmacy and infusion services, administered in the home or at alternate sites of care.

We are seeking a Senior Pharmacy Clearance Operations Manager to support our Patient Access team Remotely (USA). The successful candidate will have the opportunity to work with our talented team and contribute to our mission of improving patients' lives every day.

Estimated Salary: $70,000 - $90,000 per year

Job Description:

The Senior Pharmacy Clearance Operations Manager will oversee the clearance team, providing daily support and guidance, and participating in complex therapy benefit verification and/or prior authorization submission. Ensuring the clearance team meets or exceeds productivity and quality expectations set by the Patient Access Supervisor.

Key Responsibilities:

  • Monitor and Assign Referral Workload: Monitor and assign referral workload to clearance team members to ensure efficient processing and timely completion.
  • Generate Referral Reports: Generate referral reports weekly, bi-weekly, or monthly, and distribute them among staff with Key Performance Indicators (KPIs).
  • Train and Retrain Team Members: Train and retrain clearance specialists on new procedures, policies, and technologies to ensure they have the necessary skills to perform their duties effectively.
  • Maintain Referral Logs: Maintain ongoing logs of referrals received and completed to track progress and identify areas for improvement.
  • Counsel Team Members: Counsel clearance specialists as necessary to address performance issues, provide feedback, and encourage professional growth.
  • Escalate Referrals: Intervene or escalate referrals not processed within the required timeframe to ensure timely resolution and minimize delays.
  • Coordinate New Referral Projects: Facilitate new referral project coordination with internal customers (RBLs, Ops Managers) to ensure seamless integration and effective communication.
  • Provide Guidance on Referral Processing Standards: Provide guidance to team members regarding referral processing standards, Soleo contracts, fee schedules, therapy guidelines, and supported therapies.
  • Interpret Insurance Plans and Benefit Structures: Must have a solid working knowledge of insurance plans and benefit structures to effectively process referrals and resolve complex issues.
  • Provide Exceptional Customer Service: Provide exceptional customer service to external and internal customers, resolving any customer requests in a timely and accurate manner.

Requirements:

  • High School Diploma or Equivalent: Must have a high school diploma or equivalent.
  • Medical and Pharmacy Benefit Experience: Previous medical and pharmacy benefit experience are required.
  • Specialty Pharmacy Experience: At least 2 years of specialty pharmacy, home infusion pharmacy, and/or reimbursement experience.
  • Medicare, Medicaid, and Managed Care Reimbursement Guidelines: At least 2 years of experience applying knowledge of Medicare, Medicaid, and Managed Care reimbursement guidelines.
  • PAYOR Contract Fee Schedules: Ability to interpret payor contract fee schedules based on NDC and HCPCS units.
  • Complex Issue Resolution: Ability to effectively handle multiple priorities within a changing environment and experience in diagnosing, isolating, and resolving complex issues and recommending and implementing strategies to resolve problems.
  • Collaboration and Strategy Development: Experience collaborating with internal resources to develop strategies that meet department goals within budget and established timelines.
  • Microsoft Excel and Word Skills: Intermediate level skill in Microsoft Excel and Word.

Benefits:

Soleo Health Inc offers a comprehensive benefits package, including competitive wages, 401(k) with a match, paid time off, great company culture, annual merit-based increases, paid parental leave options, affordable medical, dental, and vision insurance plans, company-paid disability and basic life insurance, HSA and FSA options, and an education assistance program.

About Us:

Soleo Health Inc is committed to diversity, equity, and inclusion. We recognize that establishing and maintaining a diverse, equitable, and inclusive workplace is the foundation of business success and innovation. We are dedicated to hiring diverse talent and to ensuring that everyone is treated with respect and provided an equal opportunity to thrive.

Equal Opportunity Employer:

Soleo Health Inc is an Equal Opportunity Employer, celebrating diversity and committed to creating an inclusive environment for all employees. Soleo Health Inc does not discriminate in employment on the basis of race, color, religion, sex, pregnancy, gender identity, national origin, political affiliation, sexual orientation, marital status, disability, genetic information, age, membership in an organization, parental status, military service or other non-merit factor.

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