- Catholic Health Services (Melville, NY)
- …why Catholic Health was named Long Island's Top Workplace! Job Details The Appeals and Authorization representative will perform activities to resolve ... authorization denials for ambulatory practices, and facilitate appeals for hospital based services. SPECIFIC RESPONSIBILITIES AND DUTIES Review all … more
- Vanderbilt University Medical Center (Nashville, TN)
- …JOB SUMMARY Assists in financial clearance relating to patient care with occasional guidance. Screens patients for referral to other funding resources. . KEY ... RESPONSIBILITIES * Obtains certification from insurance companies for all office visits. * Verifies insurance information and registers cases in tracking system. * Evaluates patient assets and liabilities to determine ability to pay. * Reviews alternatives to… more
- VNS Health (Manhattan, NY)
- …to State Fair Hearings. Attends Fair Hearings in person with the Grievance and Appeals ' RN Specialist and presents arguments in defense of the appeals ... OverviewResolves grievances, appeals and external reviews for VNS Health Plans...as needed. + Conducts review of requests for prior authorization of health services, as required in certain product… more
- LA Care Health Plan (Los Angeles, CA)
- Customer Solution Center Appeals and Grievances Nurse Specialist LVN II Job Category: Clinical Department: CSC Appeals & Grievances Location: Los Angeles, ... safety net required to achieve that purpose. Job Summary The Customer Solution Center Appeals and Grievances Nurse Specialist LVN II is primarily responsible for… more
- VNS Health (Manhattan, NY)
- OverviewResolves grievances, appeals and external reviews for one of the following VNS Health Plans product lines - Managed Long Term Care (MLTC), Medicare Advantage ... appeal decision. Develops correspondence communicating the outcome of grievances and appeals to enrollees and/or providers. Assists with collecting and reporting… more
- US Tech Solutions (RI)
- **Job Title: Prior Authorization Specialist ** **Location: Fully remote** **Duration: 12 months contract** **Job Description:** + Prior Authorization ... courteous phone assistance to all callers through the criteria based prior authorization process. + Maintains complete, timely and accurate documentation of reviews.… more
- Texas Tech University Health Sciences Center - El Paso (El Paso, TX)
- **39311BR** **Extended Job Title:** Prior Authorization Specialist **Org Level 1:** Texas Tech Unv Hlth Sci Ctr El Paso **Position Description:** Responsible for ... staff. + Assist in the preparation and submission of appeals for denied authorizations, including but not limited to...diploma or GED plus current certification as a Prior Authorization Certified Specialist (PACS), Certified Healthcare Access… 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
- Intermountain Health (Broomfield, CO)
- …financial, and clinical information from the patient or representative. As an Insurance Authorization Specialist you need to know how to: Verify the ordering ... Work daily reports to ensure all payer specific billing requirements and authorization requirements are met. Obtain and verify necessary demographic and billing… more
- AdventHealth (Denver, CO)
- …or altered. After gathering clinical information, responsible for obtaining prior authorization for infusion and injectable medications based on provider orders and ... insurance and facility product preferences. Monitors authorization progress and communicates updates regarding insurance denial, approval, or peer to peer… more