- Humana (Austin, TX)
- …+ Deep understanding of pharmacy operations, PBM models, benefits coordination, prior authorization workflows, and specialty care dynamics + Exceptional ... project management skills; able to build clear technical implementation plans, manage cross-functional teams, and drive accountability + Ability to thrive in a fast-paced environment; balances strategic thinking with tactical execution and can simplify… more
- Centene Corporation (Austin, TX)
- …services to ensure level of care and services are medically appropriate + Performs prior authorization reviews related to mental health and substance abuse to ... determine medical appropriateness in accordance with regulatory guidelines and criteria + Performs concurrent review of behavioral health (BH) inpatient to determine overall health of member, treatment needs, and discharge planning + Analyzes BH member data to… more
- Actalent (Plano, TX)
- …procedures + using EMR system + sterilization + insurance verification + prior authorization + scheduling Schedule: Monday-Friday 8:30am-5:00pm Pay/Benefits: + ... $23/hour + milage reimbursement + health, dental, vision coverage + 401k Requirements: + medical assisting certification/diploma + 2+ years of medical assisting experience + reliable transportation Apply today! Only one spot available! Job Type & Location This… more
- Catholic Health Initiatives (The Woodlands, TX)
- …Performs all insurance verification processes and completes all required processes for prior authorization or other actions required by payers. Coordinates ... collection, processing, maintenance, storage, retrieval, documentation and distribution of medical records per policy and procedure. Assures documentation of logs of medical record release. Works on problems of diverse scope where analysis of data requires… more
- Humana (Austin, TX)
- …Solutions ensuring compliance with programmatic requirements, such as claims processing, prior authorization , formulary management and clinical programming + ... Represents Humana at all Pharmacy Medicaid meetings including those with the Michigan Department of Health and Human Services (MDHHS) **Use your skills to make an impact** **Required Qualifications** + Bachelor's degree in Pharmacy or Doctor of Pharmacy… more
- Ascension Health (Austin, TX)
- …by identifying the appropriate next steps. + Initiate and support prior authorization requests, including gathering clinical information, submitting forms, ... and following up with providers and payers as needed. + Communicate with patients by phone to provide updates, clarify prescription details, obtain missing information, and ensure excellent customer service. + Coordinate with prescribers' offices to request… more
- Elevance Health (Grand Prairie, TX)
- …for the interpretation and data entry of moderately complex prescriptions, prior authorization processing, and troubleshooting adjudication issues. **How you ... will make an impact:** + Verifies member information and inputs data for the pharmacists. + Educates members about prescriptions and medication resources or assistance programs. + Educates members on medication adherence-related topics to align closely with… more
- Bausch + Lomb (Austin, TX)
- …and private payers, foundational knowledge of benefit verifications and prior authorization /pre-determination requirements. + All reimbursement activities are ... required to be conducted and managed within all appropriate legal and regulatory guidelines and require continuous monitoring of compliance with such guidelines and laws. + Public speaking / presentations / education experience required. + Knowledge of private… more
- UTMB Health (League City, TX)
- …of immunizations + Works with patients, providers, and payers to obtain prior authorization + Resolves billing/adjudication issues encountered in the processing ... of prescription + Proficient in the use of financial assistance software + Proficient in C2 safe operation and/or OR anesthesia narcotic reconciliation + Advanced skill in the use of technology within area of assignment + Works with leaders and team members to… more
- UTMB Health (Webster, TX)
- …of immunizations + Works with patients, providers, and payers to obtain prior authorization + Resolves billing/adjudication issues encountered in the processing ... of prescription + Proficient in the use of financial assistance software + Proficient in C2 safe operation and/or OR anesthesia narcotic reconciliation + Advanced skill in the use of technology within area of assignment + Works with leaders and team members to… more