Prior Authorization Coordinator - Remote

Job Description

Soleo Health is seeking a Prior Authorization Coordinator to support our Specialty Infusion Pharmacy and work Remotely (USA). Join us in Simplifying Complex Care! Specialty infusion prior authorization experience required. Hours are Monday-Friday 8:30am-5pm Central.

Monday-Friday 8:30am-5pm Central Time

• 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

• Must have a solid working knowledge of insurance plans and benefit structures in order to obtain detailed benefit information and maximize plan benefits
• Verify insurance benefit information monthly via multiple methods such as online tools, calling payors or processing test claims
• Generates a prior authorization expiration report weekly, bi-weekly, or monthly
• Review clinical documents for prior authorization/pre-determination submission purposes
• Secures prior authorization, pre-determination, or medical review
• Contact prescriber’s office to obtain information that is required to complete ongoing re-authorization and verification of benefits
• Places outbound calls to patients or prescriber’s offices to notify of any delays due to more information needed to process or due to a prior authorization
• Document insurance coverage of medications, administration supplies, and related infusion services including prior authorization requirements and coordination of benefits
• Provides exceptional customer service to external and internal customers, resolving any customer requests in a timely and accurate manner
• Ensures the appropriate notification of patients in regards to their financial responsibility, benefit coverage, and payor authorization for services to be provided
• Generates patient forms
• Maintains up to date prior authorization report
• Other duties as assigned

• High school diploma or equivalent required
• At least 2 years of specialty infusion intake/admissions and/or reimbursement experience
• Previous medical and pharmacy benefit experience is required
• Initiating and securing prior authorizations, pre-determination, and appeals
• Ability to interpret payor contract fee schedules based on NDC and HCPCS units
• Ability to effectively handle multiple priorities within a changing environment
• Basic level skill in Microsoft Excel and Word

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.

$20-$23 per hour