Prior Authorization Coordinator

Soleo Health Inc•Frisco, TX

4h•Remote

About The Position

Soleo Health is seeking a Prior Authorization Coordinator to support our Specialty Infusion Pharmacy and work Remotely (USA). Join us in Simplifying Complex Care! This role ensures seamless patient care by maintaining prior authorizations, copay assistance, and verifying existing insurance coverage for ongoing services. The Prior Authorization Coordinator must have a solid working knowledge of insurance plans and benefit structures to obtain detailed benefit information and maximize plan benefits. They will verify insurance benefit information monthly via multiple methods such as online tools, calling payors or processing test claims. Responsibilities include generating a prior authorization expiration report weekly, bi-weekly, or monthly, reviewing clinical documents for prior authorization/pre-determination submission purposes, and securing prior authorization, pre-determination, or medical review. The coordinator will contact the prescriber’s office to obtain information required for ongoing re-authorization and verification of benefits, and place outbound calls to patients or prescriber’s offices to notify of any delays. They will document insurance coverage of medications, administration supplies, and related infusion services including prior authorization requirements and coordination of benefits, provide exceptional customer service, and ensure appropriate notification of patients regarding their financial responsibility, benefit coverage, and payor authorization. The role also involves generating patient forms and maintaining an up-to-date prior authorization report, along with other duties as assigned.

Requirements

High school diploma or equivalent required.
At least 2 years of specialty infusion intake/admissions.
Previous medical and pharmacy benefit experience is required.
Experience 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.

Nice To Haves

Specialty infusion prior authorization experience required.

Responsibilities

Maintain prior authorizations, copay assistance, and verify existing insurance coverage for ongoing services.
Obtain detailed benefit information and maximize plan benefits by understanding insurance plans and benefit structures.
Verify insurance benefit information monthly via 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 for ongoing re-authorization and verification of benefits.
Place outbound calls to patients or prescriber’s offices to notify of any delays.
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 requests in a timely and accurate manner.
Ensure appropriate notification of patients regarding their financial responsibility, benefit coverage, and payor authorization for services.
Generate patient forms.
Maintain up to date prior authorization report.
Perform other duties as assigned.