- University of Miami (Miami, FL)
- …CORE FUNCTIONS: + Adhere and perform timely prospective review for services requiring prior authorization as well as timely concurrent review for continuation of ... for expedited requests and prioritizes caseload accordingly + Maintains knowledge regarding payer reimbursement policies and clinical guidelines. + This list of… more
- St. Luke's University Health Network (Allentown, PA)
- …Responsible for reviewing medical necessity of genetic testing/infusion services in addition to prior authorization to ensure revenue for services. + Monitors a ... cash collection for all services assigned to ensure proper reimbursement . The intent of this job description is to...lines. + Utilizes specific Epic Work Queues designed for Prior Authorization and Insurance Referral workflows to… more
- St. Luke's University Health Network (Allentown, PA)
- …serve, regardless of a patient's ability to pay for health care. The Network Prior Authorization and Referral Specialist is responsible for the coordination of ... information + Provides insurance company with clinical information necessary to secure prior - authorization or referral + Works in alignment with Central… more
- BrightSpring Health Services (Oklahoma City, OK)
- …nationwide through our growing network of branches and healthcare professionals. The Prior Authorization Specialist will be responsible for activities relating ... of prior authorizations. This role requires working knowledge of pharmacy benefits and prior authorization process. Mon - Fri 8:30AM - 5:30PM Central Time *… more
- Glens Falls Hospital (Glens Falls, NY)
- …the collection of patient financial obligations / secure payment arrangements * Contact provider/ payer to obtain prior authorization * Gather additional ... coordination of benefit * Prepare and compile necessary documentation to secure prior authorization .Collect clinical information regarding service to be rendered… more
- Glens Falls Hospital (Glens Falls, NY)
- …the collection of patient financial obligations / secure payment arrangements . Contact provider/ payer to obtain prior authorization . Gather additional ... & coordination of benefit . Prepare and compile necessary documentation to secure prior authorization . . Collect clinical information regarding service to be… more
- Jennie Stuart Medical Center, Inc. (Hopkinsville, KY)
- …Department by accurately verifying insurance information, reviewing patient accounts for prior authorization needs, obtaining needed prior authorizations, ... systems, phone communication, and other resources to determine insurance eligibility and prior authorization needs for a scheduled patient event. + Verifies… more
- Baptist Memorial (Memphis, TN)
- … strategy. Specifically the managed care techniques the Coordinator uses focuses on prior authorization for services using evidence based criteria. Areas of work ... include payer notification, authorization management, denial management, escalations, and communication and coordination between payer , business office and… more
- Methodist Health System (Mansfield, TX)
- …professional responsible for verification of medical coverage, along with notification, prior authorization , and/or pre-determination of healthcare benefits for ... proposed medical services, to ensure reimbursement for rendered care. This position routinely works with...authorization and resolve issues that arise during the prior authorizations process. Supports and promotes the vision, mission,… more
- Trinity Health (Albany, NY)
- … authorization and denials within assigned service line ensuring appropriate prior authorization for related services, drugs, treatments, and supplies. ... knowledge of the patient population and types of services patients receive. + Prior authorization experience involving drugs and ancillary testing desirable. +… more
- Baptist Memorial (Memphis, TN)
- …per insurance medical policies/ FDA/NCCN guidelines. Initiates and coordinates pre-certifications/ prior -authorizations per payer guidelines prior to ... all authorization denial communications received in order to optimize reimbursement Requirements, Preferences and Experience Education Minimum Required 3 - 5… more
- University of Michigan (Ann Arbor, MI)
- …and obtaining prior authorizations for all Medicare, Medicaid and Third-Party payer equipment orders delivered by WSS. This includes but is not limited to ... Customer Service Representative Senior/Intermediate - Authorization Apply Now **How to Apply** A cover...3 years or more of experience in Complex Rehabilitation reimbursement /insurance coverage is desired. **Senior** + Experience working with… more
- Penn State Health (Hershey, PA)
- …School Diploma or equivalent required. + Two (2) years of experience in Prior Authorizations in either a Pharmacy or a Clinical setting required. **KNOWLEDGE, ... data within the patient's EMR. + Ability to understand third party payer and insurance complexities. + Ability to communicate professionally with all patients,… more
- AbbVie (Naperville, IL)
- …Payers. Examples include criteria changes or barriers in medical policy, Prior Authorization requirements, coding changes, claim submission requirements or ... of Durysta, Ozurdex and XEN Gel Stent reimbursement process, appropriate reimbursement , and respective payer landscape. + Demonstrates competence in the… more
- Regeneron Pharmaceuticals (Phoenix, AZ)
- … Payer Formularies and restrictive Utilization Management Criteria including: Prior Authorization Processes, Step Edits, Appeals, detailed Clinical ... relates to the Regeneron product portfolio. Support the company and divisional reimbursement strategy for Regeneron products within various payer segments. The… more
- Regeneron Pharmaceuticals (WI)
- … Payer Formularies and restrictive Utilization Management Criteria including: Prior Authorization Processes, Step Edits, Appeals, detailed Clinical ... relates to the Regeneron product portfolio. Support the company and divisional reimbursement strategy for Regeneron products within various payer segments. The… more
- LifePoint Health (Wilson, NC)
- …Growing Tree On-Site Childcare Facility . And much more *_Position Summary_*: The Prior Authorization Coordinator is an essential part of a multi-disciplinary ... team that provides high-quality patient care. The Prior Authorization Coordinator processes all inbound ...incoming authorization requests according to urgency, obtain authorization via the payer website or by… more
- Bausch + Lomb (Seattle, WA)
- …foundational knowledge of benefit verifications and prior authorization /pre-determination requirements and knowledge of reimbursement processes within ... with a unique HCPCS code. + Knowledge of private payer , Medicare and Medicaid structure, systems, and reimbursement... payer , Medicare and Medicaid structure, systems, and reimbursement process. + Ability to analyze and interpret regulation… more
- Regeneron Pharmaceuticals (Dallas, TX)
- … Payer Formularies and restrictive Utilization Management Criteria including: Prior Authorization Processes, Step Edits, Appeals, detailed Clinical ... relates to the Regeneron product portfolio. Support the company and divisional reimbursement strategy for Regeneron products within various payer segments. The… more
- Pfizer (New York, NY)
- …local/regional payer landscape, payer coverage and formulary change updates, payer policies (eg, prior authorization , step edits, specialty pharmacy ... Pfizer North America, this individual will report directly to I&I Access & Reimbursement Regional Director. The Field Reimbursement Colleague will perform their… more