- St. Luke's University Health Network (Allentown, PA)
- …PCP and Specialty service lines. + Utilizes specific Epic Work Queues designed for Prior Authorization and Insurance Referral workflows to ensure correct ... Responsible for reviewing medical necessity of genetic testing/infusion services in addition to prior authorization to ensure revenue for services. + Monitors a… more
- St. Luke's University Health Network (Bethlehem, PA)
- …Acquire and submit all necessary clinical information to insurance company needed to obtain prior authorization in a timely fashion + Obtains knowledge of any ... we serve, regardless of a patient's ability to pay for health care. The Referral Scheduling Specialist is a liaison between the providers and the patients. They are… more
- Tufts Medicine (Stoneham, MA)
- …under supervision. An entry level role that typically requires little to no prior knowledge or experience, work is routine or follows standard procedures, work is ... under supervision. An entry level role that typically requires little to no prior knowledge or experience, work is routine or follows standard procedures, work is… more
- Trinity Health (Grand Haven, MI)
- …testing in timely fashion with proper documentation. + Works denied claims for missing prior authorization or referral within the EMR system. + Confirms ... a medical office required. + Extensive knowledge of the insurance market & prior authorization requirements. + Billing and coding knowledge and experience… more
- Luke Staffing (GU)
- …TRICARE benefit for approval. + Ensures Line of Duty paperwork is on file prior to authorization . + Verify eligibility of beneficiaries using Defense Eligibility ... **NURSE - REFERRAL MANAGEMENT** **SITE OF SERVICE:** + Anderson Air...communication between beneficiaries, team members, internal staff and providers, network /outside providers and ancillary health care workers. + Reviews… more
- Praxis Health (Bend, OR)
- …and we value our employees. Benefit Highlights: + Medical, Dental, Vision with In- Network & Custom Network discounts + 401(K) with discretionary employer match ... testing performed in house Duties of this position will include obtaining prior authorizations for services that are not customary plan benefits, calling on… more
- Pine Rest Christian Mental Health Services (Grand Rapids, MI)
- …behavioral health system in the country, our 220-acre main campus, and our network of clinical sites across Michigan. We are a tight-knit community of healers ... incredible work. What Will You Do?As an Assessment & Referral Clinician at Pine Rest, you'll be part of...including interfacing with insurance and managed care companies for authorization . + Refer patients to outpatient services, either within… more
- Pine Rest Christian Mental Health Services (Grand Rapids, MI)
- …behavioral health system in the country, our 220-acre main campus, and our network of clinical sites across Michigan. We are a tight-knit community of healers ... work. What Will you Do? As an Assessment & Referral Registered Nurse (ARRN) at Pine Rest, you'll be...including interfacing with insurance and managed care companies for authorization . + Refer patients to outpatient services within or… more
- St. Luke's University Health Network (Allentown, PA)
- …needs change, the services may be performed at any level within the Network 's continuum of services and/or sites. JOB DUTIES AND RESPONSIBILITIES: + Demonstrates ... care. + Arranges for community services (including short and long-term placement) prior to discharge to meet patient's needs with recognition and documentation of… more
- Bassett Healthcare (Sherburne, NY)
- …a go to person for coworkers. + Obtains prior approval or prior authorization as needed. Communicates referral appointment and appointment instructions ... point of contact for patients within the Bassett Healthcare Network . This is a key role in the patient...Medicare regulations. + Obtains prior approval or prior authorization as needed. Communicates referral… more
- CenterWell (Cheyenne, WY)
- …lead strategy and execution for our referral management and specialist network solutions, including prior authorization and related EMR-integrated ... Define and track KPIs related to referral throughput, network utilization, and prior authorization efficiency; use data to drive continuous improvement.… more
- Bassett Healthcare (Cooperstown, NY)
- …Patient Access Review Sessions (PARS) + Obtains prior approval or prior authorization as needed. Communicates referral appointment and appointment ... point of contact for patients within the Bassett Healthcare Network . This is a key role in the patient...urgent referrals same day. Processes electronic or written routine referral requests within 24-72 hours + In regards to… more
- Community Health Systems (Gadsden, AL)
- …follows up with the insurance company until there is resolution of the prior authorization request - an approval, redirection, or denial. All activity ... linked to the referral requested. + Validates continuity of care and network integrity based on service line availability for quality patient care. + Sends all… more
- University of Virginia (Charlottesville, VA)
- …out of network ' for services. b. Informs patients about the authorization status as necessary. c. Prepares patient financial liability estimates and takes ... staff is accomplished in a timely manner to ensure accurate pre-certification/ authorization information is aligned with accurate billing of services. i.… more
- State of Connecticut, Department of Administrative Services (Hartford, CT)
- …+ 8:00am-4:30pm + Hybrid schedule The Role: + Oversee the claim and prior authorization review processes, dental regulations and procedure adherence, management ... with dental vendor to ensure the timely handling of prior authorization claim reviews; + Evaluate the...and changes from the Department to the vendors, provider network and community partners; + Conduct professional relations between… more
- Covenant Health Inc. (Knoxville, TN)
- …+ Verifies insurance coverage on each new referral taken. + Obtains a Prior Authorization and or Recertification when required by the insurance company. + ... Receives referrals and new orders on patients. Responsible for verification, prior authorization , and Recertification of insurance. Negotiates pricing with… more
- Covenant Health Inc. (Knoxville, TN)
- …of Covenant Health (http://www.covenanthealth.com) , our region's top-performing healthcare network . Position Summary: The Clinical Field Staff Supervisor (CFSS) ... success of providing by effectively facilitating the relationship between referral sources, patients, caregivers and employees. Recruiter: Madeline Fornadel ||… more
- Actalent (Centennial, CO)
- …patient care is a plus. + Familiarity with EMR systems, medical terminology, and prior authorization processes. + Pharmacy Technician certification is a plus. + ... Coordinator, you will be responsible for processing referrals received from referral sources, ensuring all required documentation is received to process referrals… more
- University of Rochester (Rochester, NY)
- …gathers and sends information to insurance carrier and/or provider needed for obtaining referral or prior authorization for required preliminary testing. + ... plays a valuable support role in achieving the Primary Care Network goals. **SCHEDULE** + Position includes evenings/weekends/holidays **ESSENTIAL FUNCTIONS** + Must… more
- Polaris Pharmacy Services, LLC (Covina, CA)
- … prior authorizations, step therapy, and specialty drug restrictions. . Determine whether prior authorization reviews are handled by the payer directly or by ... of Rx BINs, PCNs, Group numbers, and payer identification. . Understanding of prior authorization routing and third-party review processes. . Experience with… more