Prior Authorization Coordinator

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

📋 Description

• Facilitate uninterrupted patient care by managing prior authorizations, copay assistance, and confirming insurance coverage for ongoing services.

• Confirm insurance benefit details on a monthly basis through various methods such as online resources, contacting payors, or processing test claims.

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

• Examine clinical documents for prior authorization and pre-determination submissions.

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

• Reach out to the prescriber's office for essential information required for ongoing re-authorization and benefits verification.

• Make outbound calls to patients or prescriber's offices to inform them of any delays due to the need for additional information to process or due to prior authorization.

• Record insurance coverage details for medications, administration supplies, and associated infusion services, including prior authorization requirements and coordination of benefits.

• Deliver outstanding customer service to both external and internal clients, addressing any customer inquiries promptly.

• Ensure timely communication with patients regarding their financial obligations, benefit coverage, and payor authorization for the services to be provided.

• Create patient forms as needed.

• Keep the prior authorization report up to date.

⛳️ Requirements

• High school diploma or equivalent is mandatory.

• A minimum of 2 years of experience in healthcare intake/admissions and/or reimbursement is required.

• Prior experience in medical and pharmacy benefits is essential.

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

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

• Proficiency in managing multiple priorities in a dynamic environment.

• Basic skills in Microsoft Excel are required.

• Basic skills in Microsoft Word are required.

🏝️ 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