- University of Rochester (Rochester, NY)
- …**Responsibilities:** GENERAL PURPOSE Serves as the patient referral and prior authorization specialist, with oversight of data and compliance to enterprise ... standards and referral and prior authorization guidelines. Communicates regularly with patients, families, clinical and...an active member of the care team. Acquire insurance authorization for the visit and, if applicable, any testing;… more
- University of Rochester (Rochester, NY)
- …coverage determination, patient out of pocket determination, determination of prior authorization requirements. The PAR will communicate with the prescriber's office ... to submit claims to the patient's insurance for approval including prior authorization and helping enroll patients in financial assistance programs. The PAR will… more
- University of Rochester (Rochester, NY)
- …submit prescriptions to the patient's insurance for approval including prior authorization and helping enroll patients in financial assistance programs and arrange ... including pharmacists, pharmacy technicians, medical/clinical staff, and central prior authorization staff. External interactions include third party payors, governmental… more
- WMCHealth (Valhalla, NY)
- …in the escalation of clinical questions to the pharmacist on duty + Prior Authorization & Billing Management: + Initiate and manage prior authorization requests ... daily billing operations, including submission of claims and coordination with prior authorization technicians as needed + Process patient payments at the designated… more
- Centers Plan for Healthy Living (Staten Island, NY)
- …members enrolled in our Managed Long Term Care program and facilitate authorization requests for eligible members. PRIMARY RESPONSIBILITIES: + Assists in the prior ... authorization of services and ongoing authorization requests + Assists in completing authorization updates as needed based on the care plan of the member +… more
- University of Rochester (Rochester, NY)
- …ensures compliance to enterprise standards and referral and prior authorization guidelines. Communicates regularly with patients, families, clinical and non-clinical ... active member of the care team. + Acquires insurance authorization for the visit and, if applicable, any testing...Documents all communications pertaining to the referral and/or insurance authorization in the notes section of the electronic health… more
- Mount Sinai Health System (New York, NY)
- …not limited to, oversight of staff responsible for the prompt attention to prior authorization of specialty medications, oversight of the quality of work done in key ... or related health care administrative, and a strong familiarity with the prior authorization process preferred. Working knowledge of third party payer plans and how… more
- University of Rochester (Rochester, NY)
- …customer needs and/or organizational requirements/goals. ESSENTIAL FUNCTIONS + Analyzes authorization for medical information/PHI to evaluate for HIPAA compliance ... prior to processing. + Determines if the authorization contains all of the elements required under HIPAA...subjective and still be acceptable under HIPAA. + Analyzes authorization carefully to ensure it completely follows the true… more
- Evolent (Albany, NY)
- …ensuring the effective and efficient management of operations related to prior authorization services for healthcare companies. This role is essential in upholding ... and manage processes that enhance efficiency and effectiveness in handling prior authorization requests. + Analyze call metrics and other performance indicators to… more
- Evolent (Albany, NY)
- …professionals who work with national health plans to ensure that prior authorization and financial coding stay accurate, compliant, and aligned with evolving needs. ... plays a crucial role in supporting the comprehensive management of prior authorization and financial scope within Evolent Specialty Services. Reporting to the… more