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Soleo Health · 1 month ago

Infusion Reimbursement Contract Specialist

United States

Contract

Remote

Mid Level

$21/hr - $25/hr

4+ years exp

Soleo Health is an innovative national provider of complex specialty pharmacy and infusion services. They are seeking a Reimbursement Contract Specialist to support their Specialty Infusion Pharmacy by managing reimbursement contract information and providing guidance to stakeholders on payor contracts.

BiotechnologyHealth CareService Industry

Responsibilities

Assists Reimbursement Contracts Manager in review of payor contracts and amendments

Provides consultation, education and training on payor contract requirements to Intake and Reimbursement teams

Provides timely and accurate information regarding payor reimbursement methodologies, rates and policies to stakeholders

Manages payor contract, reimbursement related resources and other payor-related documents on company intranet site

Prepares reports and assists with special projects

In collaboration with leadership, investigates payment variances for payor contract non-compliance

Qualification

Home Infusion therapiesPayor ContractsReimbursement experienceMedical insurance plansTraining material creationHome Infusion pricingMicrosoft ExcelCommunication skillsOrganizational skills

Required

At least 4 years of experience with Home Infusion therapies and associated HCPC codes

Must have experience with and thorough understanding of Payor Contracts (e.g. for audits, rate review/negotiation or reimbursement language review)

Reimbursement experience (RCM related): Auditing/root cause analysis, financial analysis, Home Infusion billing (medical) or similar

Advanced knowledge of medical insurance plans: Managed Care Organizations, Commercial, Medicare Advantage, Self-Funded, TPAs and providers at financial risk (hospital/health systems, medical group/IPA)

Experience in creation of training material or procedures (SOPs) with ability to disseminate information regarding newly executed contracts to large groups

Advanced knowledge of Home Infusion or Medical Specialty Pharmacy pricing/fee schedules

High level of organization required, with proficiency in the Microsoft suite of products, with an emphasis on Excel and PowerPoint