- Emory Healthcare/Emory University (Atlanta, GA)
- …AI strategy identifying high-value use cases: claims processing automation, prior authorization optimization, care gap identification, fraud detection, ... personalized outreach + Partner with data science teams to develop, pilot, and scale AI/ML models improving operations and member experience + Drive responsible AI governance ensuring fairness, transparency, explainability, and compliance with regulations +… more
- Owens & Minor (Salt Lake City, UT)
- …as applicable. Manages assigned patients though medical records retrieval requests, prior authorization submissions, and shipments processes. Ensures patients ... meet all insurance criteria for specific CGM and insulin pumps being ordered. Completes benefits verification and eligibility checks with insurance plan providers. Accurately selects correct product and catalog codes, and billing and insurance information.… more
- Tufts Medicine (Boston, MA)
- …compliance/payroll, staffing, scheduling/core delivery, front desk operations, revenue capture, and prior authorization for patients as needed based on insurance ... coverage. 3. Acts as the first level "go-to person" for the clerical needs of the program including timesheets, office supply and check requests, managing mail and billing of contractees, developing, printing and dissemination of program fliers and family… more
- Owens & Minor (Salt Lake City, UT)
- …applicable. 3. Manages assigned patients though medical records retrieval requests, prior authorization submissions, and shipments processes. 4. Ensures patients ... meet all insurance criteria for specific CGM and insulin pumps being ordered. Completes benefits verification and eligibility checks with insurance plan providers. 5. Accurately selects correct product and catalog codes, and billing and insurance information.… more
- Northwell Health (New Hyde Park, 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
- MaineGeneral Health (Waterville, ME)
- …clerical duties as assigned, including filing, reception, scheduling, scribing, data entry, prior authorization and patient registration. What you will have: + ... Positive attitude and team-oriented! + Proficiency in a suite of Microsoft Office applications and multiple computer applications + Ability to work independently, effectively manage time and multiple priorities, and problem-solve within a team setting. +… 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
- CVS Health (Austin, TX)
- …with Microsoft Office applications (Outlook, Teams, Excel) **Preferred Qualifications** + Prior Authorization or Utilization Management experience in Medicare ... lines of business + Managed care experience + Experience using Med Compass + Ambulatory surgery experience **Education** Associates degree required BSN preferred **Anticipated Weekly Hours** 40 **Time Type** Full time **Pay Range** The typical pay range for… more
- SSM Health (Reedsburg, WI)
- …for coinsurance, copays, and self-pay items. + Obtains written orders and prior authorization for appropriate equipment/supplies. + Ensures compliance with ... Medicare, Medicaid and Accreditation Standards. + Works in a constant state of alertness and safe manner. + Performs other duties as assigned. EDUCATION + High School diploma/GED or 10 years of work experience EXPERIENCE + Two years' experience PHYSICAL… more
- Cardinal Health (Columbia, SC)
- …cycle management specialists simplify and optimize the practice's revenue cycle, from prior authorization through billing and collections, with a strong emphasis ... on oncology practice needs. **_Job Purpose:_** The Manager, Revenue Cycle Management, is responsible for overseeing the insurance collection follow-up team to ensure timely and accurate resolution of outstanding insurance claims. This role leads development,… more