Prior Authorization Coordinator

Soleo Health Inc•Frisco, TX

just now•Remote

About 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: 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 Other duties as assigned

Requirements

High school diploma or equivalent required
At least 2 years of specialty infusion 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 and Word

Responsibilities

Maintaining prior authorizations
Maintaining copay assistance
Verifying existing insurance coverage for ongoing services
Obtaining detailed benefit information and maximize plan benefits
Verifying insurance benefit information monthly via multiple methods such as online tools, calling payors or processing test claims
Generating a prior authorization expiration report weekly, bi-weekly, or monthly
Reviewing clinical documents for prior authorization/pre-determination submission purposes
Securing prior authorization, pre-determination, or medical review
Contacting prescriber’s office to obtain information that is required to complete ongoing re-authorization and verification of benefits
Placing 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
Documenting insurance coverage of medications, administration supplies, and related infusion services including prior authorization requirements and coordination of benefits
Providing exceptional customer service to external and internal customers, resolving any customer requests in a timely and accurate manner
Ensuring the appropriate notification of patients in regards to their financial responsibility, benefit coverage, and payor authorization for services to be provided
Generating patient forms
Maintaining up to date prior authorization report
Other duties as assigned