- Mount Sinai Health System (New York, NY)
- …but not limited to, oversight of staff responsible for the prompt attention to prior authorization of specialty medications, oversight of the quality of work ... or related health care administrative, and a strong familiarity with the prior authorization process preferred. Working knowledge of third party payer plans and… more
- Centers Plan for Healthy Living (Staten Island, NY)
- …authorization requests for eligible members. PRIMARY RESPONSIBILITIES: + Assists in the prior authorization of services and ongoing authorization requests ... the care plan of the member + Coordinates with providers regarding authorization activities + Coordinates communication between authorization clinical staff,… more
- Albany Medical Center (Albany, NY)
- …with HIPAA 270/271 and 278 transaction sets + Knowledge of denial management and prior authorization trends + Prior involvement in Epic implementations or ... and optimization of the Epic Real-Time Eligibility (RTE) and Real-Time Authorization (RTA) modules to ensure seamless insurance verification and authorization… more
- Guthrie (Cortland, NY)
- …the coordination of Utilization Management (UM) processes and requirements of prior authorization /certification for reimbursement of patient care services. The ... payers, Care Coordination and other hospital departments as appropriate to obtain prior authorization required to meet contractual reimbursement requirements and… more
- Highmark Health (Albany, NY)
- …claims history, clearly defines the medical necessity of non-formulary and prior authorization medication exception requests. Interacts with pharmacy network ... Prioritize requests for drug authorizations or denials. + Review of prior authorization criteria for drug products. + Recommend staffing adjustments necessary to… more
- University of Rochester (Rochester, NY)
- …information to submit prescriptions to the patient's insurance for approval including prior authorization and helps enroll patients in financial assistance ... of the most common payors for the relevant administered drugs that require prior authorization (PA), and will be responsible for working with the prior … more
- University of Rochester (Rochester, NY)
- …information to submit prescriptions to the patient's insurance for approval including prior authorization , and helps enroll patients in financial assistance ... of the most common payors for the relevant administered drugs that require prior authorization (PA), and will be responsible for working with the prior … more
- CenterWell (Albany, NY)
- …Specialty Care to lead strategy and execution for our referral management, payer prior authorization , and specialist network solutions. This role is critical to ... Define and track KPIs related to referral throughput, network utilization, and prior authorization efficiency; use data to drive continuous improvement. +… more
- Catholic Health Services (Melville, NY)
- …through an online system to secure authorizations for scheduled procedures requiring an authorization , prior to the date of service. Responsibilities: + Utilize ... needed and understand payer specific criteria to appropriately secure authorization and clear the account prior to...appropriately secure authorization and clear the account prior to service where possible. + Ensure that initial… more
- University of Rochester (Rochester, NY)
- …policies of the most common payors for the relevant administered drugs that require prior authorization (PA) and works with the prior authorization ... in advance of requesting PA. Initiates, documents, and tracks all prior authorization on behalf of the location(s) to improve patient experience, ensure… more