- 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 (Englewood, CO)
- …nationwide through our growing network of branches and healthcare professionals. The Prior Authorization Specialist will be responsible for activities relating ... prior authorizations. This role requires working knowledge of pharmacy benefits and prior authorization process. Mon - Fri 8:30AM - 5:30PM This position has… more
- Select Medical (Lakeway, TX)
- …A joint venture with Select Medical & Baylor Scott & White Health ** Prior Authorization Specialist -** **onsite only** **This position must work** **onsite** ... and independent judgment, the Payor Relations Specialist manages the pre-certification and prior authorization of referrals scheduled for admission to the Acute… more
- HonorHealth (Scottsdale, AZ)
- …including frequency and dosage prior to treatment and reviews the applicable payer reimbursement criteria to ensure that the specific payer 's medical ... through the HonorHealth Network. Preforms tasks related to the management of prior authorization for patients served by HonorHealth Research Institute. Reviews… more
- Select Medical (West Orange, NJ)
- **Overview** **Kessler Institute for Rehabilitation** West Orange, NJ ** Prior Authorization Specialist/Payor Relations Specialist - This is an** **onsite** ... and independent judgment, the Payor Relations Specialist manages the pre-certification and prior authorization of referrals scheduled for admission to the Acute… 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
- HonorHealth (Phoenix, AZ)
- …including frequency and dosage, prior to treatment and reviews the applicable payer reimbursement criteria to ensure that the specific payer 's medical ... as necessary to become proficient. Perform tasks related to the management of prior authorization for patients served by infusion clinics. Reviews medical… 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
- 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
- J&J Family of Companies (Grand Rapids, MI)
- …* Reimbursement or relevant managed care experience (revenue cycle, buy-and-bill, prior authorization , coding, and appeals processes) * Ability to establish ... * Immunology disease state experience * Advanced degree and/or relevant certifications in prior authorization and/or billing and coding * Strong market access… more
- Keystone Lab (Asheville, NC)
- …fees, covered or non-covered items, diagnosis, modifiers, valid HCPC, prescriptions, authorization , eligibility, etc. + Monitor websites for payer policy ... opportunity awaits a highly qualified Medical Insurance Billing & Reimbursement Analyst I in one of the most beautiful...in all aspects of job performance. + Adhere to payer timely filing limits and work accounts to resolve… more
- Fairview Health Services (Minneapolis, MN)
- …to pharmacy services while documenting accurate referral and reimbursement ( payer ) information, coordinating the intake and benefit authorization process + ... coding. Knowledge of medical benefit investigation and securing or prior authorization securing for medical benefit. + **License/Certification/Registration**… more
- Bayer (SC)
- …+ years Field Reimbursement experience; + In depth understanding of Payer /PBM therapy approval requirements ( Prior Authorization , Medical Necessity, ... experience, State Medicaid, and Managed Plans; + Experience in educating and supporting Prior Authorization process, appeals, and denials; + Covermymeds - portal… more
- Daiichi Sankyo Inc. (Seattle, WA)
- …in formulary decisions, reimbursement policy, utilization management criteria, prior authorization processes and appeal requirements. Develop ongoing ... around rare diseases and immune disorders. **Summary:** The Associate Director, Field Reimbursement (ADFR) is a critical front-line member of the DSI oncology Field… more
- Daiichi Sankyo Inc. (Boston, MA)
- …in formulary decisions, reimbursement policy, utilization management criteria, prior authorization processes and appeal requirements. Develop ongoing ... around rare diseases and immune disorders. **Summary:** The Associate Director Field Reimbursement (ADFR) is a critical front-line member of the DSI oncology Field… more
- Hackensack Meridian Health (Neptune, NJ)
- … prior authorizations when needed in order to avoid technical denials for lack of prior authorization . Understand if payer rules governing when or if a ... in the HMH Health care system. This pertains to Prior Authorization for Oncology services, as well...reimbursement . + Ensure accurate completion of Medicare Secondary Payer Questionnaire. + Performs insurance verification on all Inpatient… more
- Catholic Health Services (Melville, NY)
- … is needed and understand payer specific criteria to appropriately secure authorization and clear the account prior to service where possible. Ensure that ... system to secure authorizations for scheduled procedures requiring an authorization , prior to the date of service....Stay abreast of changes in Medicare, Medicaid and third-party payer reimbursement requirements. Requirements: Minimum of 1… more