Prior Authorization Coordinator

This is a fully remote position, open to applicants in United States.

📋 Description

• Oversee prior authorizations, assist with copay support, and confirm current insurance coverage for ongoing services.

• Gather comprehensive insurance benefit details to optimize plan advantages.

• Monthly verification of insurance benefit details utilizing online resources, communication with payors, and testing claims.

• Produce reports on prior authorization expirations on a weekly, bi-weekly, or monthly basis.

• Review clinical documentation for prior authorization and pre-determination submissions.

• Obtain prior authorization, pre-determination, or medical review as necessary.

• Reach out to prescribers’ offices to gather information for re-authorization and benefits verification.

• Conduct outbound calls to patients or prescribers’ offices concerning processing delays and missing information.

• Record insurance coverage for medications, administration supplies, and related infusion services.

• Deliver prompt and precise customer service to both internal and external clients.

• Inform patients about their financial responsibilities, benefit coverage, and payor authorizations.

• Create patient forms as required.

• Keep prior authorization reports up to date.

⛳️ Requirements

• A minimum of 2 years of experience in home infusion specialty pharmacy, including prior authorizations, test claims, and HCPC calculations.

• Required specialty home infusion experience.

• At least 2 years of experience with prior authorizations is mandatory.

• High school diploma or equivalent is essential.

• Previous experience in medical and pharmacy benefits is necessary.

• Experience initiating and securing prior authorizations, pre-determination, and appeals.

• Ability to interpret payor contract fee schedules based on NDC and HCPCS units.

• Capability to manage multiple priorities in a dynamic environment effectively.

• Availability Monday through Friday from 9:30 AM to 6:00 PM Central Standard Time.

🏝️ Benefits

• 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