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Remote Optum Prior Authorization Jobs (NOW HIRING)

CareMed Specialty Pharmacy

$23 - $25/hr

Pharmacy Prior Authorization Specialist - CareMed Specialty Pharmacy Buffalo, NY | Full-Time | ... Remote work possible after initial on-site training. Company Benefits * Medical; Dental; Vision ...

PainPoint

Prior Authorization Coordinator

Atlanta, GA · On-site +1

$19 - $21/hr

Prior Authorization Coordinator Full-Time | $19-21/hour | Monday-Friday | 8:00 AM-4:30 PM CST ... Remote About DxTx Pain & Spine At DxTx Pain & Spine, we're redefining how pain and spine practices ...

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Remote Optum Prior Authorization information

What is the difference between Remote Optum Prior Authorization vs Remote Optum Claims Reviewer?

AspectRemote Optum Prior AuthorizationRemote Optum Claims Reviewer
CredentialsTypically requires healthcare-related certifications, such as RN, LPN, or medical coding credentialsOften requires similar healthcare certifications, with focus on claims processing
Work EnvironmentRemote, healthcare insurance setting, interacting with providers and patientsRemote, insurance claims processing environment, reviewing submitted claims
Employer & Industry UsageCommonly employed by health insurance companies like Optum, focusing on authorization processesEmployed by insurance companies, focusing on claims review and reimbursement

Remote Optum Prior Authorization specialists focus on obtaining approvals for healthcare services, while Remote Optum Claims Reviewers evaluate submitted claims for accuracy and reimbursement. Both roles require healthcare knowledge and certifications, but differ in their primary functions within the insurance process.

What is a Remote Optum Prior Authorization job?

A Remote Optum Prior Authorization job involves reviewing and processing requests from healthcare providers to determine whether certain medical procedures, medications, or services will be covered under a patient's insurance plan. Employees in this role work from home and use clinical guidelines to assess the necessity and appropriateness of requested treatments. They collaborate with providers, patients, and insurance teams to ensure timely authorization decisions. This position typically requires strong communication skills, attention to detail, and familiarity with healthcare regulations and insurance policies.

What are the key skills and qualifications needed to thrive as a Remote Optum Prior Authorization Specialist, and why are they important?

To thrive as a Remote Optum Prior Authorization Specialist, you need strong knowledge of medical terminology, insurance processes, and prior authorization protocols, typically supported by a healthcare-related degree or relevant experience. Familiarity with electronic health record (EHR) systems, insurance verification tools, and prior authorization software is essential. Excellent attention to detail, organizational skills, and effective communication are vital soft skills for efficiently managing high volumes of authorization requests and collaborating with providers. These skills ensure accurate, timely approvals and help optimize patient care while reducing administrative delays.

How does a Remote Optum Prior Authorization specialist typically interact with healthcare providers and insurance teams?

As a Remote Optum Prior Authorization specialist, you will regularly communicate with healthcare providers, pharmacies, and insurance representatives to obtain and verify necessary information for authorizing medical procedures or medications. Most interactions occur via phone, secure messaging, or electronic health record systems, requiring clear communication and attention to detail. Collaboration is essential, as you'll often need to clarify clinical documentation with providers and ensure compliance with insurance guidelines. This role is well-suited for those who are organized, proactive, and comfortable working independently within a supportive virtual team environment.
More about Remote Optum Prior Authorization jobs
What cities are hiring for Remote Optum Prior Authorization jobs? Cities with the most Remote Optum Prior Authorization job openings:
What are the most commonly searched types of Optum Prior Authorization jobs? The most popular types of Optum Prior Authorization jobs are:
What states have the most Remote Optum Prior Authorization jobs? States with the most job openings for Remote Optum Prior Authorization jobs include:
What job categories do people searching Remote Optum Prior Authorization jobs look for? The top searched job categories for Remote Optum Prior Authorization jobs are:
Remote Optum Prior Authorization jobs near you
Infographic showing various Remote Optum Prior Authorization job openings in the United States as of May 2026, with employment types broken down into 75% Full Time, and 25% Part Time. Highlights an 100% Remote job distribution.
Prior Authorization Coordinator - Remote

Prior Authorization Coordinator - Remote

Soleo Health Inc

Frisco, TX • On-site, Remote

$20 - $23/hr

Full-time

Medical, Dental, Vision, Life, Retirement, PTO

Posted 14 days ago

Job description

Description:

Soleo Health is seeking a Prior Authorization Coordinator to support our Specialty Infusion Pharmacy and work Remotely (USA). Join us in Simplifying Complex Care!


Specialty infusion prior authorization experience required. Hours are Monday-Friday 8:30a-5p Central.


Soleo Health Perks:

  • 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


The Position:

The Prior Authorization Coordinator ensures seamless patient care by maintaining prior authorizations, copay assistance, and verifying existing insurance coverage for ongoing services. Responsibilities include:

  • Must have a solid working knowledge of insurance plans and benefit structures in order to obtain detailed benefit information and maximize plan benefits
  • Verify insurance benefit information monthly via multiple methods such as 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 that is required to complete ongoing re-authorization and verification of benefits
  • Places outbound calls to patients or prescriber’s offices to notify of any delays due to more information needed to process or due to a prior authorization
  • Document insurance coverage of medications, administration supplies, and related infusion services including prior authorization requirements and coordination of benefits
  • Provides exceptional customer service to external and internal customers, resolving any customer requests in a timely and accurate manner
  • Ensures the appropriate notification of patients in regards to their financial responsibility, benefit coverage, and payor authorization for services to be provided
  • Generates patient forms
  • Maintains up to date prior authorization report
  • Other duties as assigned



Schedule:

  • Monday-Friday 8:30a-5pm Central Time
Requirements:
  • High school diploma or equivalent required
  • At least 2 years of specialty infusion intake/admissions and/or reimbursement experience
  • 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
  • Basic level skill in Microsoft Excel and Word


About Us: Soleo Health is an innovative national provider of complex specialty pharmacy and infusion services, administered in the home or at alternate sites of care. Our goal is to attract and retain the best and brightest as our employees are our greatest asset. Experience the Soleo Health Difference!


Soleo’s Core Values:

  • Improve patients’ lives every day
  • Be passionate in everything you do
  • Encourage unlimited ideas and creative thinking
  • Make decisions as if you own the company
  • Do the right thing
  • Have fun!


Soleo Health is committed to diversity, equity, and inclusion. We recognize that establishing and maintaining a diverse, equitable, and inclusive workplace is the foundation of business success and innovation. We are dedicated to hiring diverse talent and to ensuring that everyone is treated with respect and provided an equal opportunity to thrive. Our commitment to these values is evidenced by our diverse executive team, policies, and workplace culture.


Soleo Health is an Equal Opportunity Employer, celebrating diversity and committed to creating an inclusive environment for all employees. Soleo Health does not discriminate in employment on the basis of race, color, religion, sex, pregnancy, gender identity, national origin, political affiliation, sexual orientation, marital status, disability, genetic information, age, membership in an organization, parental status, military service or other non-merit factor.


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