Prior Authorization Coordinator

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Soleo Health

WebsiteLinkedInAll Job Openings

501 - 1000 employees

Founded 2013

⚕️ Healthcare Insurance

💊 Pharmaceuticals

🧘 Wellness

Healthcare Insurance • Pharmaceuticals • Wellness

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

• Ensure seamless patient care by maintaining prior authorizations, copay assistance, and verifying insurance coverage for ongoing services. • Verify insurance benefit information monthly via multiple methods such as online tools, calling payors or processing test claims. • Generate prior authorization expiration report weekly, bi-weekly, or monthly. • Review clinical documents for prior authorization/pre-determination submission. • Secure prior authorization, pre-determination, or medical review. • Contact prescriber’s office for required information for ongoing re-authorization and verification of benefits. • Place 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. • Provide exceptional customer service to external and internal customers, resolving any customer requests in a timely manner. • Ensure appropriate notification of patients regarding their financial responsibility, benefit coverage, and payor authorization for services to be provided. • Generate patient forms. • Maintain up to date prior authorization report.

🎯 Requirements

• High school diploma or equivalent required. • At least 2 years of healthcare 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 • Basic level skill in Microsoft Word

🏖️ 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