- BroadPath Healthcare Solutions (Tucson, AZ)
- …is excited to announce that we are hiring for work-at-home positions! ** Prior Authorization Representatives** will receive inbound phone calls and faxes ... medications prior authorizations only. The representatives will manage the prior authorization process for medications and provide updates on approval… more
- Insmed Incorporated (NJ)
- …share best practices, and ensure a holistic and patient-centric approach to care. Prior Authorization & Insurance Coordination: Verify insurance coverage and ... prior authorization status, and help resolve any barriers to treatment;...and experience with health insurance, Medicare Part D coverage, prior authorization process, and Rx reimbursement, specifically… more
- Agendia, Inc (Irvine, CA)
- …services, collecting and reviewing all the necessary documentation required to submit prior authorization , contacting the ordering physician or their office for ... determination. When applicable, the PA Coordinator will also submit a Prior Authorization appeal if criteria is met but the PA was denied erroneously.… more
- Merck & Co. (St. Petersburg, FL)
- …and customers in the Cardiovascular sector.Solid understanding of Rx Pathways, and prior authorization process.Track record of leading successful product launch ... teams in competitive markets.Proficient in leveraging business analytics and technology to generate insights, develop strategies, and execute plans, while coaching sales teams to utilize these tools effectively.Minimum Requirements - Skills and… more
- Genmab (Berkeley Heights, NJ)
- …not limited to Medicare, Medicaid and commercial insurance carriers, Prior Authorization submissions/appealsUnderstanding of the healthcare industry, including ... of insurance coverage including review of benefit verifications, research of prior authorizations and support through the appeals processEvaluate and refer patients… more
- PharmaCord (Jeffersonville, IN)
- …Identifies and communicates patient's plan benefit coverage including the need for prior authorization , appeal, tier exception, and/or formulary exclusions Uses ... from the PharmaCord pharmacy Proactively communicates needs for reverification of prior authorization or re-enrollment for patient assistance program Reports… more
- Stony Brook University (Stony Brook, NY)
- …and document all financial clearance information in the patient's EMR including, prior authorization verification number, effective start and end dates, and ... companies through online portal, phone, or fax to initiate authorization , obtain insurance benefits, eligibility, medical necessity, and/or authorization… more
- Premera Blue Cross (Mountlake Terrace, WA)
- …Coordinator** - **Clinical Appeals** performs prospective review (benefit advisory/ prior authorization ) admission, concurrent, and retrospective reviews ... necessity review that includes inpatient review, concurrent review, benefit advisory/ prior authorization , retrospective, out of network, and appropriateness… more
- Commonwealth Care Alliance (Boston, MA)
- …Director of Utilization Management - Oversees clinical decision review for services requiring prior authorization in a variety of clinical areas, including but ... (must have): - Expertise in managing utilization review processes including prior authorization , concurrent and retrospective reviews - Demonstrated ability… more
- CoxHealth (Lake Spring, MO)
- …plans and works with insurance companies to obtain predetermination or authorization for certain procedures. This position works alongside different departments ... Diploma or Equivalent Experience: ▪ Preferred: 2 years customer service or prior experience with third party payers Skills: ▪ Understanding of medical terminology… more
- Seattle Children's (Seattle, WA)
- …technical understanding of CMS/Medicaid regulations and/or commercial payor billing or prior authorization requirements, and ability to accurately interpret ... understanding of CMS/Medicaid regulations and/or Commercial Payor billing, referral and/or prior authorization requirements and ability to accurately interpret… more
- Tidelands Health (Myrtle Beach, SC)
- …multiple resources for patient services. May also perform duties for prior authorization , referrals (incoming/outgoing), good faith estimates, and/or payment ... identifying deductibles, copayments, coinsurance, and policy limitations. Obtains referral, authorization and pre-certification information if needed; documents this information… more
- Commonwealth Care Alliance (Boston, MA)
- …Duties & Responsibilities:** + Conducts timely clinical decision review for services requiring prior authorization in a variety of clinical areas, including but ... **Required Knowledge, Skills & Abilities (must have):** + Experience with prior authorization and retrospective reviews + Proficiency reviewing clinical/medical… more
- Stanford Health Care (Pleasanton, CA)
- …Proficiency In At Least ONE of the Following Specialized Functions:- Medication Prior Authorization - Specialized Data Collection & Coordination- Cross-trained to ... is accurate, and assist with general questions about appointments, authorization , payments, billing, and schedules.- Patient Escalations: Seek, Identifies, and… more
- Premera Blue Cross (Mountlake Terrace, WA)
- …internal and external stakeholders. + Support and assist in administering Pharmacy Prior Authorization and other clinical pharmacy programs. + Provide clinical ... + (2) years of experience as a pharmacist. **(Required)** + Prior authorization experience strongly preferred. + An advanced degree (eg, PharmD, MBA,… more
- Premera Blue Cross (Mountlake Terrace, WA)
- …necessity review that includes inpatient review, concurrent review, benefits advisory/ prior authorization , retrospective, out of network, and appropriateness ... a thorough understanding of the Plan's provider contracts, member contracts, authorization requirements and clinical criteria including Milliman care guidelines and… more
- Tidelands Health (Myrtle Beach, SC)
- …multiple resources for patient services. May also perform duties for prior authorization , referrals (incoming/outgoing), good faith estimates, and/or payment ... + Assisting with procedures. + Preparing and administering medications with physician's authorization , + Performing EKGs. + Using CPR skills when required. + Drawing… more
- Jobleads-US (Chicago, IL)
- …to Recruitment Agencies:** Resumes submitted for this or any other position without prior authorization from Human Resources will be considered unsolicited. BWS ... and / or its affiliates will not be responsible for any fees associated with unsolicited submissions.We are an Equal Opportunity Employer. We do not discriminate on the basis of age, ancestry, color, gender, gender expression, gender identity, genetic… more
- Tidelands Health (Murrells Inlet, SC)
- …multiple resources for patient services. Will also perform duties for prior authorization , referrals (incoming/outgoing), good faith estimates, and/or payment ... identifying deductibles, copayments, coinsurance, and policy limitations. Obtains referral, authorization and pre-certification information if needed; documents this information… more
- Moses/Weitzman Health System (East Haven, CT)
- …by laws in a timely manner, included by not limited to intake, prior authorization request, progress notes, treatment plan documentation, and discharge. + ... Completes and locks all treatment notes no later than the end of the next business day. + Completes reports as required for outside agencies such as DCF, Family Relations, probation, and others with appropriate releases signed by clients. + Participates as a… more
