- Catholic Health Services (Melville, NY)
- …discover why Catholic Health was named Long Island's Top Workplace! Job Details The Appeals and Authorization Representative will perform activities to help ... limited to the following: Review providers' requests for services and coordinate appeals management review. Generate an appeal letter to substantiate the medical… more
- Veterans Benefits Administration (IN)
- …review and assessment of compensation and pension development, award processing, and authorization , to include legacy appeals , AMA decision reviews, and attorney ... is not a virtual position. Position Description/PD#: Veterans Service Representative ( Authorization Quality Review Specialist); GS-12 PD#37136A… more
- Intermountain Health (Broomfield, CO)
- …all necessary demographic, financial, and clinical information from the patient or representative . Details: As an Insurance Authorization Specialist you need to ... Work daily reports to ensure all payer specific billing requirements and authorization requirements are met. Obtain and verify necessary demographic and billing… more
- US Tech Solutions (May, OK)
- …phone assistance to all callers through the criteria based prior authorization process. Maintains complete, timely and accurate documentation of reviews. Transfers ... assigned by the leadership team. Work closely with providers to process prior authorization (PA) and drug benefit exception requests for multiple clients or lines of… more
- Veterans Benefits Administration (Chicago, IL)
- Summary The Veterans Service Representative ( Authorization Quality Review Specialist) is an integral part of the VSC and BEST quality assurance program and is a ... pension claims. Responsibilities Performs individual quality reviews to determine the authorization quality level of individual VSRs for purposes of individual… more
- CVS Health (Phoenix, AZ)
- …has an exciting opportunity for a Senior Representative within our Prior Authorization & Appeals Administration department. In this role, the Senior Rep will ... - 1 plus years of experience in the CVS Caremark Prior Authorization and Appeals Administration department - Must be considered in good attendance and… more
- Houston Methodist (Cypress, TX)
- At Houston Methodist, the Case Management Representative position is responsible for providing clerical assistance and data management support to the case management ... securing signatures on the form from the patient or their legal representative , and answering questions regarding the appeal process + Distributes the Medicare… more
- Molina Healthcare (Bowling Green, KY)
- …guidelines, and CMS standards. + Provides coordination and processing of pharmacy prior authorization requests and/or appeals . + Explains Point of Sale claims ... those involved in formulary management (such as, reviewing prior authorization requirements, reviewing drug/provider utilization patterns and pharmacy costs… more
- Corewell Health (Grand Rapids, MI)
- …prior authorization has been obtained; assists with retroactive insurance denials/ appeals . + Responsible for complex EMR/EHR scanning and Right Fax faxing and ... Job Summary As a Patient Services Representative with Corewell Health, you'll play a vital...+ Ability to perform the role of Patient Services Representative , Associate when necessary. + Actively participates in safety… more
- Commonwealth Care Alliance (Boston, MA)
- …members and all those involved in CCA members' care. The Member Service Representative (MSR) is responsible to provide a best-in-class service experience to all ... appointments, transportation, translation, and interpretation services. + Initiates prior authorization intake process. + Assist in resolving member billing… more