Prior Authorization Coordinator

About the role

Soleo Health is seeking a Prior Authorization Coordinator to support our Specialty Infusion Pharmacy and work Remotely (USA). Join us in Simplifying Complex Care! Must have at least 2 years of home infusion specialty pharmacy experience, including prior authorizations, running test claims, and HCPC calculations. Hours are Monday-Friday 9:30am - 6pm Central Standard Time.

Responsibilities

• 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

Requirements

• Specialty home infusion