- Molina Healthcare (Buffalo, NY)
- …stay for requested treatments and/or procedures. * Conducts reviews to determine prior authorization /financial responsibility for Molina and its members. * ... 2 years experience, including experience in hospital acute care, inpatient review, prior authorization , managed care, or equivalent combination of relevant… more
- Amgen (Syracuse, NY)
- …order to reimbursement, supporting the entire reimbursement journey through payer prior authorization to appeals/denials requirements and forms + Review ... coverage/utilization management criteria, insurance forms & procedures, benefits investigation, prior authorization , appeal, and/or claims resolution + Educate… more
- YAI (Manhattan, NY)
- …to secure approvals or letters of medical necessity to support requests for prior authorization of medication requests, submitting documentation on behalf of ... saving, uploading and/or entering notes relating to requests, follow-ups and/or prior authorization approvals for prescription medications in accordance with… more
- Cardinal Health (Albany, NY)
- …management specialists simplify and optimize the practice's revenue cycle, from prior authorization through billing and collections. The Billing Representative ... other duties and projects as assigned. + Accurately verify claims for required authorization and provider credentialing prior to submission. + Reference and… more
- CDPHP (Latham, NY)
- …coverage and CDPHP initiatives. The pharmacy tech will support initiatives including prior authorization work under the guidance of a licensed pharmacist. ... and external customers. + Must be conscientious, efficient and accurate in prior authorization , exception and medical/Rx necessity review processing. +… more
- Evolent (Albany, NY)
- …working seamlessly with diverse teams and stakeholders. + Deep understanding of prior authorization processes, reporting, and key performance indicators (eg, ... + Strategic Data Analytics & Insights: Lead advanced analyses of healthcare authorization , claims, membership data, and clinical outcomes to uncover cost drivers,… more
- CDPHP (Latham, NY)
- …I is primarily responsible for the operational review of pharmacy medical exception/ prior authorization requests, the communication to members and providers on ... professionals required. + Experience with managed care pharmacy principles including prior authorization reviews, formulary management, and utilization review… more
- Evolent (Albany, NY)
- …with healthcare claims, reimbursement methodologies, and cost/utilization KPIs, including prior authorization data and key performance indicators (eg, ... Doing:** + **Data Analytics & Insights** : Analyze healthcare claims and authorization data to identify cost drivers, utilization trends, and population health… more
- University of Rochester (Rochester, NY)
- …access drugs in assigned clinics. Collaborates with clinical staff to acquire prior authorization for relevant providers, investigates benefits, enrolls patients ... of the major payers for the relevant clinic-administered drugs that require prior authorization (PA) and is responsible for working with the clinic providers,… more
- Arnot Health (Elmira, NY)
- …Assists in tracking/trending by payer for denial reason items such as prior authorization , untimely filing, coordination of benefits, services type issues, ... on Bonus for qualified Case Managers! MAIN FUNCTION: The Case Management (denial/ prior auth) will review and appeal as appropriate for concurrent and retrospective… more
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