Prior Authorization Coordinator

The Position

The Prior Authorization Coordinator ensures seamless patient care by maintaining prior authorizations, copay assistance, and verifying existing insurance coverage for ongoing services. Responsibilities include:

• Maintain a solid working knowledge of insurance plans and benefit structures 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.
• Generate a prior authorization expiration report weekly, bi-weekly, or monthly.
• Review clinical documents for prior authorization/pre-determination submission purposes.
• Secure 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.
• 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 and accurate manner.
• Ensure the appropriate notification of patients in regards to their financial responsibility, benefit coverage, and payor authorization for services to be provided.
• Generate patient forms.
• Maintain up to date prior authorization report.

Requirements

• A 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.

About Us

Soleo Health is an innovative national provider of complex specialty pharmacy and infusion services, administered in the home or at alternate sites of care. Our goal is to attract and retain the best and brightest as our employees are our greatest asset. Experience the Soleo Health Difference!

Soleo’s Core Values

• Improve patients’ lives every day
• Be passionate in everything you do
• Encourage unlimited ideas and creative thinking
• Make decisions as if you own the company
• Do the right thing
• Have fun!

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

Pay

Commensurate with experience.

Schedule

Monday-Friday 9:00am-5:30pm Eastern Standard Time.

Equal Opportunity Employer

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.