Clearance Specialist – Eligibility Representative

Soleo Health

Clearance Specialist remotely handling patient eligibility and authorization for a Specialty Infusion Pharmacy. Processing referrals and benefit verifications while working full time in a fast-paced environment.

Posted 7/31/2026full-timeRemote • 🇺🇸 United StatesJuniorMid-Level💰 $23 - $27 per hourWebsite

Core Competencies

Role fit

Core Competencies

Use this summary to align your resume positioning with the role.

Demonstrates expertise in patient eligibility verification, claim adjudication, and prior authorization processes within home infusion specialty pharmacy. Proficient in interpreting Medicare, Medicaid, and managed care reimbursement guidelines while ensuring compliance with HIPAA regulations.

Highest-signal resume keywords

Patient Eligibility VerificationClaim AdjudicationPrior Authorization ProcessesHome Infusion Specialty Pharmacy ExperienceKnowledge of Medicare and Medicaid Guidelines

ATS Keywords

Tailor your resume

Applicant Tracking System Keywords

Tip: use these terms in your resume and cover letter to boost ATS matches.

Hard Skills

HCPC Code CalculationBenefit VerificationPayer Authorization RequestsFinancial Responsibility CalculationDocumentation of CoverageMulti-taskingFast-paced Environment Adaptability

Soft Skills

Strong CommunicationOrganizational Skills

Tools & Technologies

Microsoft ExcelMicrosoft WordCPR+

Industry Keywords

Home InfusionManaged CareReimbursement GuidelinesHIPAA Regulations

About the role

Key responsibilities & impact

Process new referrals including verifying patient eligibility
Test claim adjudication
Coordination of benefits
Identifying patient estimated out of pocket costs
Preparation, submission, and follow up of payer authorization requests
Perform benefit verification of all patient insurance plans
Document coverage of medications, administration supplies, and related infusion services
Document all information related to coinsurance, copay, deductibles, authorization requirements
Calculate estimated patient financial responsibility based on benefit verification and payer contracts
Initiate, follow-up, and secure prior authorization, pre-determination, or medical review
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
Refer or assist with enrollment any patients who express financial necessity to manufacturer copay assistance programs and/or foundations
Generate new patient start of care paperwork

Requirements

What you’ll need

High school diploma or equivalent
Experience running test claims and calculating HCPC codes required.
At least 2 years of home infusion specialty pharmacy and/or medical intake/reimbursement experience preferred
Working knowledge of Medicare, Medicaid, and managed care reimbursement guidelines including ability to interpret payor contract fee schedules based on NDC and HCPCS units
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
Knowledge of HIPAA regulations
Basic level skill in Microsoft Excel & Word
Knowledge of CPR+ preferred

Benefits

Comp & perks

Competitive Wages
401(k) with a Match
Referral Bonus
Paid Time Off
Great Company Culture
Annual Merit Based Increases
No Weekends or Holidays
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