- Corewell Health (Grand Rapids, MI)
- …customers on drug formulary guidelines, including drug formulary alternatives and prior authorization criteria. Consistently create an exceptional experience ... provides customers with information and education concerning the drug formulary and prior authorization (coverage determination) requests and ensuring they are… more
- Molina Healthcare (Sterling Heights, 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 (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
- TEKsystems (Plymouth, MI)
- …case-by-case research requirements, troubleshooting issues related to prior authorization status, medication coverage, formulary questions, and pharmacy ... - interviews are first come, first serve!** Job Title: Customer Service Representative Hours: must be available to work between Monday-Sunday 5a-10pm (your shift… more
- TEKsystems (Plymouth, MI)
- …this role, you will handle inbound patient and provider calls, support prior authorization inquiries, and deliver exceptional customer service while navigating ... ⭐ Customer Service Representative - Healthcare Call Center (On‑Site) Plymouth, MI...members, providers, and pharmacies. + Answer questions related to prior authorizations, medication coverage, and general inquiries, including confidential… more
- TEKsystems (Livonia, MI)
- …as needed (50-100 calls/day depending on complexity). + Respond to questions on prior authorization and general inquiries with professionalism. + Enter and ... About the Role Join our team as a Customer Service Representative in a dynamic call center environment. You'll handle inbound calls, provide accurate information on … more
- Cardinal Health (Lansing, MI)
- …care and timely access to necessary services + Assist in obtaining insurance, prior authorization , and appeal requirements and outcomes + Help patients ... streamline patient onboarding, qualification and adherence. Our non-commercial specialty pharmacy is centralized at our custom-designed facility outside of Dallas,… more