Remote Prior Authorization Specialist - Specialty Pharmacy

Soleo Health; United States; Remote; USD 28,000 - 32,000; Full time

Benefits offered by this job

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

Company Paid Disability & Basic Life

HSA & FSA Options

Education Assistance Program

Job summary

Soleo Health is seeking a Prior Authorization Coordinator to support our Specialty Infusion Pharmacy and work remotely in the USA. The role focuses on maintaining prior authorizations, copay assistance, and verifying ongoing insurance coverage for services.

You will have at least 2 years of home infusion specialty pharmacy experience, including prior authorizations and HCPC calculations, with typical hours Monday through Friday 9:30am–6pm Central.

Qualifications

• 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.

Responsibilities

• Maintains prior authorizations, copay assistance, and verifies insurance coverage for ongoing services.
• Verify insurance benefit information monthly via 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 required to complete ongoing re-authorization and verification of benefits.
• Places outbound calls to patients or prescriber’s offices to notify of delays due to more information needed.
• Document insurance coverage of medications and related infusion services including prior authorization requirements and coordination of benefits.
• Provide exceptional customer service to external and internal customers, resolving requests timely and accurately.
• Ensure notification of patients regarding financial responsibility, benefit coverage, and payor authorization for services.
• Generates patient forms.
• Maintains up-to-date prior authorization report.

Job description

Soleo Health is seeking a Prior Authorization Coordinator to support our Specialty Infusion Pharmacy and work remotely in the USA. The role focuses on maintaining prior authorizations, copay assistance, and verifying ongoing insurance coverage for services.

You will have at least 2 years of home infusion specialty pharmacy experience, including prior authorizations and HCPC calculations, with typical hours Monday through Friday 9:30am–6pm Central.