- University of Rochester (Rochester, NY)
- …some interpretation; maintains an expert-level understanding of the department/division + Prior authorization functionality will be required for testing and ... medical information outside of URMC. + It also includes getting prior authorization for surgeries that may require speaking with insurance company nurses… more
- Mount Sinai Health System (New York, NY)
- …but not limited to, oversight of staff responsible for the prompt attention to prior authorization of specialty medications, oversight of the quality of work ... or related health care administrative, and a strong familiarity with the prior authorization process preferred. Working knowledge of third party payer plans and… more
- US Tech Solutions (LA)
- **Position Summary:** As a Prior Authorization Nurse, you work outside the walls of a hospital setting in a specialty area of the nursing field providing ... utilization management prior authorization reviews. Build strong direct relationships with providers and medical directors through review of member clinical… more
- Sharp HealthCare (San Diego, CA)
- …primary care physician with knowledge of managed care and the process for prior authorization review. + California Physicians and Surgeons License - Medical ... authorization .Provides strong leadership and direction for appropriate and efficient prior authorization services. + TrainingParticipate in Milliman and Hayes… more
- Henry Ford Health System (Detroit, MI)
- … Support: Efficiently validate insurance coverage and determine when medication prior authorization is required, ensuring accuracy and compliance with ... formulary medications, NDCs, and corresponding HCPCS codes to ensure accurate prior authorization , billing, and reimbursement. Collaborate with pharmacists,… more
- Beth Israel Lahey Health (Westwood, MA)
- …**Essential Responsibilities:** 1. Understands product and payer reimbursement landscape and prior authorization guidelines and processes. 2. Collects and ... reviews all data needed pharmacy and/or medical for prior authorization approvals. 3. Resolves insurance related issues, including prior authorizations… more
- St. Luke's Health System (Boise, ID)
- …regulations, and insurance guidelines. + Stays updated on insurance policy changes, prior authorization trends, and oncology treatment protocols. + Performs ... pharmacy staff, coders, and insurance companies, to navigate the treatment authorization process and secure prior authorizations for oncology treatments,… more
- Beth Israel Lahey Health (Needham, MA)
- …authorization requirements for the Clinics. Ensures all exams requiring a Prior Authorization and/or Referral are coordinated through the appropriate ... prior authorizations and documents in OMR. Makes follow up calls to prior authorization agents as needed to ensure timely turnaround of prior … more
- Billings Clinic (Billings, MT)
- …across Billings Clinic. This position ensures that pre-registration, insurance verification, prior authorization , and patient financial counseling processes are ... analyzing and reporting key performance indicators (KPIs), including registration accuracy, prior authorization turnaround, and patient satisfaction Compliance /… more
- Globus Medical, Inc. (Collegeville, PA)
- …support to customers from the initial processing of received documentation through prior authorization , appeals support, detailed claims review, and hotline ... payer coverage expertise and support regarding all phases of the prior authorization process, appeals, and all related patient access activities with all… more
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