- Evolent (Albany, NY)
- …Managers to ensure successful adoption and engagement of Evolent's solutions (ie, prior authorization , clinical pathways) to ensure timely patient access to ... care and drive high provider satisfaction, measured by CSAT and NPS scores + Support the development and execution of innovative engagement opportunities such as regional clinical symposiums and local provider experience advisory panels + Own market level… more
- Heath System Services (Niagara Falls, NY)
- …meet payer requirements, including benefit verification, medical necessity qualification, and prior authorization . + Maintain adherence to Medicare, Medicaid, ... and commercial payer standards. + Act as a resource for billing and coverage policy questions from team members. Technical Proficiency: + Utilize and oversee multiple ordering platforms and ERP systems. + Train team members on system use and ensure accurate… more
- Northwell Health (New York, NY)
- …to help facilitate the filling of prescriptions, handle/resolve rejections, and obtain prior authorization which will expedite prescriptions into the workflow. ... Complies with Food and Drug Administration (FDA) mandates and self-imposed manufacturer restrictions on particular drugs, as applicable including Risk Evaluation and Mitigation Strategy (REMS) programs and manufacturer limited distribution drug requirements.… more
- KPH Healthcare Services, Inc. (Syracuse, NY)
- …organizing and mailing letters to patients. + Responsible for assisting the prior authorization process for Patient Benefits Specialists by physically handling, ... faxing, organizing, or otherwise distributing paperwork + Responsible for providing support to Call Center Representatives who are not working physically in the facility + Assist call center operations with miscellaneous reporting tasks + Assist with the role… more
- UHS (Johnson City, NY)
- …EHR; Ensure diagnosis codes meet Medical Necessity requirements. Acquires consent forms, prior authorization data and/ or ABN's when applicable. + Demonstrates ... ability to organize and prioritize workload with respect to STAT and routine patient testing as well as the collection of timed draws within established guidelines. + As applicable, rotates as Outpatient department receptionist, tending to outpatients… more
- Oak Orchard Health (Corfu, NY)
- …needed for Providers/patients. + Initiates and completes all parts of medication prior - authorization requests based on insurance requirements. + Perform family ... medicine/pediatric ED recalls. + Perform machine/POCT controls in accordance with manufacturer recommendations/industry standards. + Accept deliveries/orders and put supplies away. + Document refrigerator/freezer temps twice a day. + Check expiration dates:… more
- Hillside Family of Agencies (Rochester, NY)
- …process to obtain medical/psychiatric history, establish health care needs, and complete prior authorization for medications or medical necessity based on ... recommendation from medical and psychiatric team, when needed. + Review health care recommendations from youth's physician with the treatment team and family to encourage family participation and implement follow-up care recommendations. + Consult with… more
- Crouse Hospital (Syracuse, NY)
- …the health care system from the initiation of the referral, to obtaining prior authorization , scheduling appointments and tracking and following up on results. ... Required Qualifications: Registered Nurse, Demonstrated experience in a multi-specialty physician office. Excellent customer service skills. Excellent computer skills, Demonstrated competence interpersonal and intra professional relations. Demonstrated… more
- Independent Health (Buffalo, NY)
- …collecting co-payments. + Coordination of benefits. + Financial assistance coordination. + Prior Authorization assistance with offices. + Billing. + Work as ... a team member within the patient services department and all other departments to promote information sharing and continuous process improvement. + Specialists must function in strict accordance with standard, written procedures and guidelines with deviation… more
- CVS Health (Albany, NY)
- …responsible for predetermination reviews and reviews of claim determinations. This includes Prior Authorization / Pre Certification / Concurrent Reviews / Peer ... to Peer Calls / First Level Appeals / Special Projects and Committee participation when needed. The Medical Director will provide clinical, coding, and reimbursement expertise as well as directing case management when necessary. In this role you will provide… more