- Carle (Urbana, IL)
- Outpatient Denial/ Appeals Specialist - RN + Department: Revenue Cycle - CFH_10_19 + Entity: Champaign-Urbana Service Area + Job Category: Clerical/Admin + ... documentation review to establish and manage clinical and prior authorization denial appeals for the Carle enterprise. Represents Carle in clinical meetings… more
- VNS Health (Manhattan, NY)
- OverviewResolves grievances, appeals and external reviews for one of the following VNS Health Plans product lines - Managed Long Term Care (MLTC), Medicare Advantage ... appeal decision. Develops correspondence communicating the outcome of grievances and appeals to enrollees and/or providers. Assists with collecting and reporting… more
- US Tech Solutions (RI)
- **Job Title: Prior Authorization Specialist ** **Location: Fully remote** **Duration: 12 months contract** **Job Description:** + Prior Authorization ... courteous phone assistance to all callers through the criteria based prior authorization process. + Maintains complete, timely and accurate documentation of reviews.… more
- Montrose Memorial Hospital (Montrose, CO)
- …meeting the highest standards of healthcare. About The Career: + The Hospital Prior Authorization Specialist is an advocate for the patient's medical needs and ... payer to patient for timely health care diagnostics and treatments. The Prior Authorization Specialist supports the provider and patient's plan of care as… more
- University of Michigan (Ann Arbor, MI)
- Prior Authorization Specialist Apply Now **Job Summary** Processes referrals and prior authorizations using established insurance company guidelines. Obtains ... employer. **Job Detail** **Job Opening ID** 254300 **Working Title** Prior Authorization Specialist **Job Title** Patient Services Intermediate **Work Location**… more
- US Tech Solutions (May, OK)
- …phone assistance to all callers through the criteria based prior authorization process. Maintains complete, timely and accurate documentation of reviews. Transfers ... assigned by the leadership team. Work closely with providers to process prior authorization (PA) and drug benefit exception requests for multiple clients or lines of… more
- Intermountain Health (Broomfield, CO)
- …and clinical information from the patient or representative. Details: As an Insurance Authorization Specialist you need to know how to: Verify the ordering ... Work daily reports to ensure all payer specific billing requirements and authorization requirements are met. Obtain and verify necessary demographic and billing… more
- G-TECH Services, Inc. (Detroit, MI)
- Support providers and reviewers with prior authorization requests for post-acute care services. Includes manually entering authorization requests into Care ... algorithms embedded in the care management system to administratively approve prior authorization requests. May work with providers to secure discharge plans, Notice… more
- CareOregon (Portland, OR)
- …of prior authorization and formulary exception decisions. + Perform prior authorization reviews with pharmacist oversight. Appeals and Grievances + Explain ... Arizona, Nevada, Texas, Montana, or Wisconsin. Job Title Pharmacy Benefit Specialist II Exemption Status Non-Exempt Department Pharmacy Manager Title Pharmacy… more
- Abbott (Orlando, FL)
- …requests for patient-specific LOA/SCAs either directly or indirectly by working with Authorization /LOA specialists. The VOB specialist will be required to work ... insurance companies and performs follow up activities to assist in obtaining prior authorization determinations. + Files appeals for denied benefits coverage to… more
- The Mount Sinai Health System (New York, NY)
- …all aspects of the concurrent review program, insurance certification, and authorization process for all Psychiatric or Chemical Dependency Inpatient Units (subject ... Develops ongoing relationships with insurance provider case managers to maximize authorization potential. Communicates with inpatient clinical staff to insure timely… more
- Abbott (Orlando, FL)
- …helping address some of the World's greatest healthcare challenges. The Authorization /LOA Specialist , Customer Service is responsible for contacting insurance ... secure and communicate authorization determinations in a timely manner. The Authorization / LOA specialist will be responsible for appealing adverse … more
- Hartford HealthCare (Hartford, CT)
- …specialties. *_ Job Description_* Under the direction of the Manager, a Prior Authorization Specialist performs all clerical duties required to obtain insurance ... Must have consistent documentation in EPIC to support the obtained insurance authorization . Will communicates changes in payer and or federal regulatory guidelines… more
- Kelsey-Seybold Clinic (Pearland, TX)
- …a liaison to the Grievance and Appeals Department for Medicare Advantage appeals . The Utilization Review Specialist (LVN) is responsible for completion and ... **Responsibilities** The Utilization Review Specialist (LVN) is responsible for conducting medical reviews,...to determine medical necessity for health care services requiring authorization prior to services being rendered for members. The… more
- State of Colorado (Moffat County, CO)
- Highway Maintenance Specialist - Craig (CDL Required) Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/4623169) Apply Highway Maintenance ... Specialist - Craig (CDL Required) Salary $52,356.00 - $53,000.00...obtained at any time after receipt of the applicant's authorization . As part of the employment screening, an applicant… more
- LA Care Health Plan (Los Angeles, CA)
- …Compliance Audit Specialist II Job Category: Customer Service Department: CSC Appeals & Grievances Location: Los Angeles, CA, US, 90017 Position Type: Full Time ... LA Care Medi-Cal Direct program (MCLA), call documentation and categorization, service authorization request and coverage determination , Appeals and Grievances… more
- AssistRx (Orlando, FL)
- …and details on how to expedite patient access + Document and initiate prior authorization process and claims appeals + Report any reimbursement trends or delays ... A Day in the Life as a Patient Access Specialist : This role works directly with healthcare providers &...(PA) for an assigned caseload and helps navigate the appeals process to access medications. + Ensure cases move… more
- State of Colorado (Grand Junction, CO)
- Compliance Specialist - Grand Junction Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/4653245) Apply Compliance Specialist - Grand ... 26 biweekly pay periods in a year. The Compliance Specialist Administrator II classification s tarting pay is typically...obtained at any time after receipt of the applicant's authorization . As part of the employment screening an applicant… more
- State of Colorado (Denver, CO)
- Highway Maintenance Lead Specialist (TM II) - SW Denver Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/4654226) Apply Highway Maintenance ... Lead Specialist (TM II) - SW Denver Salary $69,708.00 -...obtained at any time after receipt of the applicant's authorization . As part of the employment screening an applicant… more
- State of Colorado (Alamosa, CO)
- Electronics Specialist III - Alamosa (CDL Training Provided) Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/4656308) Apply Electronics ... Specialist III - Alamosa (CDL Training Provided) Salary $71,052.00...obtained at any time after receipt of the applicant's authorization . As part of the employment screening an applicant… more