Prior Authorization Coordinator

🔥 2 minutes ago

🇺🇸 United States – Remote

💵 $20 - $23 / hour

⏰ Full Time

🟢 Junior

🟡 Mid-level

🚫👨‍🎓 No degree required

👻 Ghost score 0%

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Soleo Health

WebsiteLinkedInAll Job Openings

501 - 1000 employees

Founded 2013

🏥 Healthcare

⚕️ Healthcare Insurance

💊 Pharmaceuticals

Healthcare • Healthcare Insurance • Pharmaceuticals

Soleo Health is a specialty pharmacy company that goes beyond simply filling prescriptions by providing personalized patient experiences and access to specialized medications and infusion therapies. They offer treatment in patients' homes, in providers' offices, or at one of their many nationwide infusion centers. Soleo Health specializes in treating complex and ultra-rare diseases with a focus on improving patient quality of life and optimizing health outcomes. They work closely with patients, providers, pharmaceutical manufacturers, payors, and health systems to deliver high-cost therapies, demonstrating value through real-world outcome data. Soleo Health is recognized for its clinical excellence and dedication to patient care, and offers nationwide services, including an online portal, Soleo Connect®, for real-time communication.

📋 Description

• Maintain prior authorizations, copay assistance, and verify existing insurance coverage for ongoing services • Obtain detailed insurance benefit information and maximize plan benefits • Verify insurance benefit information monthly using online tools, calls to payors, and test claims • Generate prior authorization expiration reports weekly, bi-weekly, or monthly • Review clinical documents for prior authorization and pre-determination submissions • Secure prior authorization, pre-determination, or medical review • Contact prescribers’ offices to obtain information for re-authorization and benefits verification • Make outbound calls to patients or prescribers’ offices regarding processing delays and missing information • Document insurance coverage of medications, administration supplies, and related infusion services • Provide timely and accurate customer service to internal and external customers • Notify patients about financial responsibility, benefit coverage, and payor authorization • Generate patient forms • Maintain current prior authorization reports

🎯 Requirements

• Must have at least 2 years of home infusion specialty pharmacy experience, including prior authorizations, running test claims, and HCPC calculations • Specialty home infusion experience required • 2 years of prior authorization experience required • High school diploma or equivalent required • 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 • Monday-Friday availability, 9:30am-6:00pm Central Standard Time

🏖️ Benefits

• 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