Clearance Team Lead

1 week ago

Norcross, United States Soleo Health Inc Full time
Job DescriptionJob DescriptionDescription:

Soleo Health is seeking a full-time Clearance Team Lead to support our Patient Access team Remotely (USA). Join us in Simplifying Complex Care

Soleo Health Perks:

  • Competitive Wages
  • 401(k) with a Match
  • Referral Bonus
  • Paid Time Off
  • Great Company Culture
  • Annual Merit Based Increases
  • Paid Parental Leave Options
  • Affordable Medical, Dental, & Vision Insurance Plans
  • Company Paid Disability & Basic Life Insurance
  • HSA & FSA (including dependent care) Options
  • Education Assistance Program


The Position:

The Clearance Team Lead oversees the clearance team, provides daily support/guidance, and participates in complex therapy benefit verification and/or prior authorization submission. Ensures clearance team meets or exceeds productivity and quality expectations set by Patient Access Supervisor. Responsibilities include:

  • Monitors and assigns referral workload to clearance team
  • Generates referral reports weekly, bi-weekly, or monthly and distributes among staff with KPIs
  • Trains and retrains clearance specialists
  • Maintains ongoing log of referrals received and completed
  • Counsels clearance specialists as necessary
  • Intervenes or escalates referrals not processed within required timeframe
  • Facilitates new referral project coordination with internal customers (RBLs, Ops Managers)
  • Provides guidance to team regarding referral processing standards, Soleo contracts, fee schedules, therapy guidelines and supported therapies
  • Must have a solid working knowledge of insurance plans and benefit structures
  • In cases of escalation, places outbound calls to internal or external customers as requested to notify of delays due to benefit verification
  • Provides exceptional customer service to external and internal customers, resolving any customer requests in a timely and accurate manner


Requirements:
  • High school diploma or equivalent.
  • Previous medical and pharmacy benefit experience are required
  • At least 2 years of specialty pharmacy, home infusion pharmacy, and/or reimbursement experience
  • At least 2 years of experience applying knowledge of Medicare, Medicaid, and Managed Care reimbursement guidelines
  • Ability to interpret payor contract fee schedules based on NDC and HCPCS units
  • Ability to effectively handle multiple priorities within a changing environment
  • Experience in diagnosing, isolating, and resolving complex issues and recommending and implementing strategies to resolve problems
  • Experience collaborating with internal resources to develop strategies that meet department goals within budget and established timelines
  • Intermediate level skill in Microsoft Excel
  • Intermediate level skill in Microsoft Word


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


Soleo’s Core Values:

  • Improve patients’ lives every day
  • Be passionate in everything you do
  • Encourage unlimited ideas and creative thinking
  • Make decisions as if you own the company
  • Do the right thing
  • Have fun


Soleo Health 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. Our commitment to these values is evidenced by our diverse executive team, policies, and workplace culture.


Soleo Health is an Equal Opportunity Employer, celebrating diversity and committed to creating an inclusive environment for all employees. Soleo Health 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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