Business Development Agents (Freelance) Male/Female
Hutchison Telecommunications Lanka (Pvt) Ltd
Soleo health is seeking a prior authorization coordinator to work remotelyThis position will follow prior authorization work flow, policies and proceduresEssential 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 company’s 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
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).