Specialist Insurance Benefits Verifier

1 day ago


Phoenix, Arizona, United States Soleo Health Inc Full time

About Us

Soleo Health is an innovative national provider of complex specialty pharmacy and infusion services administered in the home or at alternate sites of care.

We are 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.

Our goal is to attract and retain the best and brightest as our employees are our greatest asset.

Job Summary:

We are seeking a highly skilled Insurance Benefits Specialist to join our team in this full-time role. This position will be responsible for verifying insurance benefits for specialty medications and services, submitting and tracking authorization requests.

The successful candidate will also be responsible for communicating updates on pending referrals and ensuring timely referral processing.

This role requires excellent communication skills, attention to detail, and the ability to multitask in a fast-paced environment.

Responsibilities:

  • Benefit Verification: Perform benefit verification of all patient insurance plans including documenting coverage of medications, administration supplies, and related infusion services.
  • Authorization Management: Responsible to document all information related to coinsurance, copay, deductibles, authorization requirements, etc.
  • Clinical Documentation: Calculate estimated patient financial responsibility based off benefit verification and payer contracts and/or company self-pay pricing.
  • Prior Authorization: Initiate, follow-up, and secure prior authorization, pre-determination, or medical review including reviewing and obtaining clinical documents for submission purposes.
  • Communication: Communicate with patients, referral sources, other departments, and any other external and internal customers regarding status of referral, coverage and/or other updates as needed.
  • Financial Assistance: Refer or assist with enrollment any patients who express financial necessity to manufacturer copay assistance programs and/or foundations.
  • New Patient Start of Care: Generate new patient start of care paperwork.

Requirements:

  • Experience: Home Infusion experience required.
  • Skills: Experience with referrals, benefit verifications and authorizations required. At least 2 years of home infusion pharmacy and/or medical intake/reimbursement experience preferred.
  • Education: High school diploma or equivalent.
  • Knowledge: Working knowledge of Medicare, Medicaid, and managed care reimbursement guidelines including ability to interpret payor contract fee schedules based on NDC and HCPCS units.
  • Soft Skills: Strong ability to multi-task and support numerous referrals/priorities while ensuring productivity expectations and quality are met. Ability to work in a fast-paced environment.
  • Certifications: Knowledge of HIPAA regulations. Basic level skill in Microsoft Excel & Word. Knowledge of CPR+ preferred.

Benefits:

  • Competitive Salary: $70,000 - $90,000 per annum.
  • Overtime Pay: Overtime as needed.
  • Paid Time Off: Paid time off available.
  • Health Insurance: Affordable Medical, Dental, & Vision Insurance Plans.
  • Disability Insurance: Company paid disability & basic life insurance.
  • FSA/HSA: FSA & HSA (including dependent care) options.
  • Referral Bonus: Referral bonus available.
  • Educational Assistance: Education assistant program.

Location: Remote (USA). Schedule: M-F 9a-530p or 830a-5p Central Time.



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