- Molina Healthcare (MI)
- …Medicare and Medicaid Services (CMS) standards. * Provides coordination and processing of pharmacy prior authorization requests and/or appeals. * Explains ... including but not limited to: formulary information, copay amounts, pharmacy location services and prior authorization...information, copay amounts, pharmacy location services and prior authorization outcomes. * Assists members and… more
- Highmark Health (Lansing, MI)
- …clearly defines the medical necessity of non-formulary and prior authorization medication exception requests. Interacts with pharmacy network providers to ... requests for drug authorizations or denials. + Review of prior authorization criteria for drug products. +...billing practices through paid clams review. + Participate as pharmacy representative in onsite member appeals and… more
- Henry Ford Health System (Troy, MI)
- …with personnel at the clinic site Communicating with insurance payors regarding authorization issues. May be the hospital representative at external meetings ... denial or with high charges are verified for accuracy prior to claim submission Managing authorization related...a full suite of home health offerings, virtual care, pharmacy , eye care and other health care retail. With… more
- Henry Ford Health System (MI)
- …with personnel at the clinic site + Communicating with insurance payors regarding authorization issues. May be the hospital representative at external meetings ... denial or with high charges are verified for accuracy prior to claim submission + Managing authorization ...a full suite of home health offerings, virtual care, pharmacy , eye care and other health care retail. With… more