Prior Authorization Coordinator

Soleo Health Inc•Atlanta, GA

5h•$20 - $23•Remote

About The Position

Soleo Health is seeking a Prior Authorization Coordinator to support our Specialty Infusion Pharmacy and work Remotely (USA). The Prior Authorization Coordinator ensures seamless patient care by maintaining prior authorizations, copay assistance, and verifying existing insurance coverage for ongoing services. This role requires a solid working knowledge of insurance plans and benefit structures to obtain detailed benefit information and maximize plan benefits. Responsibilities include verifying insurance benefit information monthly, generating prior authorization expiration reports, reviewing clinical documents for submission, securing prior authorizations, contacting prescriber's offices for necessary information, notifying patients of delays, documenting insurance coverage, providing customer service, and ensuring appropriate notification of patients regarding their financial responsibility and benefit coverage.

Requirements

Specialty infusion prior authorization experience required.
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.
Experience in 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.

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 required for ongoing re-authorization and verification of benefits.
Notify patients or prescriber’s offices of any delays due to missing information or prior authorization issues.
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.