Employer: Soleo Health
ESSENTIAL DUTIES AND RESPONSIBILITIES
- Receive requests for prior authorizations and ensure that they are properly and closely monitored within company set standards
- Review accuracy and completeness of information requested and ensure that all supporting documents are present
- Assist with medical necessity documentation to expedite approvals and ensure that appropriate follow-up is performed
- Collaborate with other departments to assist in obtaining prior authorizations/appeals
- Manage correspondence with insurance companies and internal customers as required
- Document all interactions with insurance companies within pharmacy system
- Document all prior authorization information including approval dates, billing units, procedure codes, and prior authorization number in patient profile
- Review insurance denials and submit appeals (as permitted by payor)
- Proactively work on prior authorizations that are due to be expired
- Secure patients demographics and medical information by using discretion and ensuring that all procedures are in sync with HIPAA compliance and regulation
- Conducts job responsibilities in accordance with the standards set out in the Companys Code of Business Conduct and Ethics, its policies and procedures, the Corporate Compliance Agreement, applicable federal and state laws, and applicable professional standards
- Completes all required duties, projects and reports in a timely fashion on a daily, weekly, or monthly basis per the direction of the leadership.
- Other duties as assigned
QUALIFICATION REQUIREMENTS
- At least 2 years experience in specialty pharmacy, home infusion, or other pharmacy prior authorization is required
- At least 1 year of experience applying knowledge of Medicare, Medicaid, and Managed Care reimbursement guidelines
- Ability to effectively handle multiple priorities within a changing environment
- Experience in diagnosing, isolating, and resolving complex issues and recommending and implementing strategies to resolve problems.
- Intermediate level skill in Microsoft Excel (for example: using SUM function, setting borders, setting column width, inserting charts, using text wrap, sorting, setting headers and footers and/or print scaling).
- Intermediate level skill in Microsoft Word (for example: inserting headers, page breaks, page numbers and tables and/or adjusting table columns).
