Prior Authorization Coordinator in Sanger, California at Soleo Health Inc

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.

Soleo Health Perks:

• 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

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

Schedule:

• Monday-Friday 9:30am - 6:00pm Central Standard Time

• Specialty home infusion experience required
• 2 years of prior authorization experience required
• High school diploma or equivalent required
• 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

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!

Soleo Health is committed to diversity, equity, and inclusion. We recognize that establishing and maintaining a diverse, equitable, and inclusive workplace is the foundation of business success and innovation. We are dedicated to hiring diverse talent and to ensuring that everyone is treated with respect and provided an equal opportunity to thrive. Our commitment to these values is evidenced by our diverse executive team, policies, and workplace culture.

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.