- Community Health Systems (Corsicana, TX)
- …details from physicians as needed. + Contacts insurance companies to secure prior authorization and logs all pre-certification orders in tracking systems ... and SOAP notes when necessary. + Performs other duties as assigned. + Maintains regular and reliable attendance. + Complies with all policies and standards. **Qualifications** + Coursework or certification in Healthcare Administration, Medical Office… more
- CenterWell (Austin, TX)
- …SQL Server administration and query performance tuning + Experience with healthcare and prior authorization data + Experience managing data and pipelines in a ... Databricks environment + Experience with navigating change management processes in a large enterprise environment + Experience working with an enterprise scheduling system to manage job execution Travel: While this is a remote position, occasional travel to… more
- Cardinal Health (Austin, TX)
- …and other innovation trends + Understanding of specialty drug processes, prior authorization , benefit verification, medication adherence, revenue cycle ... management etc. + Minimum of 15 years relevant experience in product management roles + Start-up experience preferred + Bachelor's degree in business administration, healthcare administration, life sciences, entrepreneurship, leadership, or a related field;… more
- Elevance Health (Houston, TX)
- …clinical guidelines within scope of license. + Conduct pre-certification or prior authorization of psychological testing and neuropsychological testing services. ... + Partners with Behavioral Health Management staff by assisting in training, attending utilization management rounds, and serving on interdepartmental initiatives; assists in developing a program around psychological and neuropsychological testing. Position… more
- UTMB Health (Galveston, TX)
- …may include inpatient decentralized/unit-based care, ambulatory/specialty pharmacy, infusion services, prior authorization or medication access programs, and ... revenue integrity functions. **ESSENTIAL JOB FUNCTIONS** . Assess medication regimens, identify and resolve therapy-related problems, and provide recommendations to optimize clinical outcomes and cost-effectiveness. . Monitor and evaluate therapeutic responses… more
- Humana (Austin, TX)
- …conducting medical necessity and comprehensive medication reviews for prescriptions requiring prior authorization . This role involves evaluating complex clinical ... scenarios and applying evidence-based criteria to ensure appropriate medication use. The pharmacist addresses moderately complex to complex issues that require critical thinking and in-depth analysis of variable factors. **_Earn a $5,000 hiring bonus!_**… more
- Cardinal Health (Austin, TX)
- …cycle management specialists simplify and optimize the practice's revenue cycle, from prior authorization through billing and collections. Job Purpose: The ... Patient AR Specialist is responsible for managing and resolving outstanding patient balances, ensuring the accuracy of accounts and supporting overall revenue cycle process. This includes, billing follow up, collections, payment posting, denial resolution, and… more
- Texas Health Resources (Fort Worth, TX)
- …pharmacy required * 2 years of previous Retail Pharmacy experience, previous prior authorization processing and prescription benefit billing experience highly ... preferred. * Sterile IV Certification highly preferred * Proficiency in written and verbal English language, computers, the ability to adapt to various software systems, and basic math including conversions, proportions, ratios, and algebra. * The ability to… more
- CVS Health (Austin, TX)
- …work schedules will include holidays and evening hours **Preferred Qualifications** + Prior Authorization or Utilization Management experience + Managed care ... experience + Experience using MedCompass + Ambulatory surgery experience **Education** + Associates degree required + Bachelor's in Nursing preferred **Anticipated Weekly Hours** 40 **Time Type** Full time **Pay Range** The typical pay range for this role is:… more
- Baylor Scott & White Health (Temple, TX)
- …clients to explain Health Plan pharmacy benefits, assist with understanding the prior authorization process, and resolve claims processing and eligibility issues ... while adhering to department policies and procedures. This position advocates on behalf of the member and serves as a liaison between the Health Plan and stakeholders to identify root causes and address concerns. In addition, the Pharmacy Services Specialist 2… more