- Hillside Family of Agencies (Auburn, NY)
- …insurance carriers. + Proactively investigate whether a specialist referral might need a prior authorization . + Provide first aid and CPR care as trained, ... when applicable. + Participate in staff meetings, in-services, and presentations. + Complete required training in a timely manner as assigned. + While this job description covers many aspects of the role, employees may be required to perform other duties as… more
- University of Rochester (Rochester, NY)
- …Utilization Management, Social Work, Patient Accounts, Medical Records, Surgeon offices, Prior Authorization Teams, Contracting and Finance. + External ... coordination includes patients, families, third party payers, Department of Social Services, Department of Health, attorneys, MVA and WC carriers, outside hospitals, governmental agencies, and external review agencies. + Explain workflow and policies to areas… more
- Centene Corporation (Tampa, FL)
- …technician or medical office (ie biller, coder, office assistance, or prior authorization /certification) experience. Familiarity with drugs commonly used to ... treat chronic/debilitating illnesses. **License and Certification - Florida** State pharmacy technician license(s) relative to where the employee and assigned pharmacy are located. License is required upon hire. (Must be a Florida Certified Pharmacy… 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
- Elevance Health (Nashville, TN)
- …office experience preferred. + Infusion experience preferred. + Medical billing, prior authorization and order verification experience preferred. Please be ... advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health. Any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health. Who We… more
- SSM Health (St. Louis, MO)
- …adherence to hospital and regulatory policies. + Performs insurance verification and prior - authorization based on payor requirements. + Works in a constant ... state of alertness and safe manner. + Performs other duties as assigned. EDUCATION + Master's degree in Behavioral Health or related field EXPERIENCE + No experience required PHYSICAL REQUIREMENTS + Frequent lifting/carrying and pushing/pulling objects… more
- Bon Secours Mercy Health (Cincinnati, OH)
- …Develop and chair a utilization management review committee and partner with the prior authorization team. + Review high-cost and high-volume referral tests for ... clinical appropriateness and develop test algorithms, where applicable. + Prepare business case proposals on appropriate buy vs sell initiatives of tests that can be internalized. Determine optimal instrumentation necessary to insource referral tests. + Track… more
- Corewell Health (Ludington, MI)
- …reconciles multi-department deposit. + Obtains insurance authorizations and/or verifies that prior authorization has been obtained; assists with retroactive ... insurance denials/appeals. + Responsible for complex EMR/EHR scanning and Right Fax faxing and uploading to EPIC. + Assists with training new team members utilizing standard work. + Ability to perform the role of Patient Services Representative, Associate when… more
- Cardinal Health (Austin, TX)
- …enrollment and reimbursement activities, benefit investigations for pharmacy benefit coverage, prior authorization assistance, copay enrollment and other patient ... services. + Collaboratively oversees daily operations for an inbound and outbound patient access support team of 70+ team members + Ability to maintain development/training goals for team members in a 100% remote setting + Responsible for creating and… more
- Humana (Washington, DC)
- …+ 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