- CVS Health (Austin, TX)
- …health care more personal, convenient and affordable. **Position Summary** Prior Authorizations & Appeals Coordinator will be responsible for performing ... non-clinical activities and functions in accordance with policies and procedures, under the supervision of the Clinical Supervisor. Responsible for reviewing and maintaining compliance with ERISA, CMS, Medicaid, and client specific requirements. Works as part… more
- Trinity Health (Darby, PA)
- …and authorizations . + Familiarity with the construction of professional appeals in response to denied claims. **Qualifications:** + PA Registered Nurse or ... **Description:** Trinity Health Mid-Atlantic is looking for Clinical Pre-Service Nurse Coordinator to join our Pre-Service team! **Employment Type:** Full Time… more
- HonorHealth (Scottsdale, AZ)
- … I position within the HonorHealth Research Institute initiates and obtains prior authorizations for clinical trials and continuing care infusion/chemotherapy ... administrative teams to prevent denials by ensuring medical necessity and obtaining prior authorizations promptly. Coordinating the approval process for white… more
- Children's Hospital Boston (Boston, MA)
- …on the process for obtaining and responding to additional requests for prior authorizations for medicines across relevant insurance companies for supported ... by effectively coordinating services to patients and families. The Patient Administrative Coordinator will: + Manage the prior authorization process for patients… more
- Fallon Health (Worcester, MA)
- **Overview** **The Service Coordinator works M - F 8 am to 5 pm and will require at least 6 months of training 5 days/week in the office and then will require 2 ... of purpose** : Under the direction of the Manager of Prior Authorization, communicates with contracted and non-contracted facilities/agencies/providers to collect… more
- Rush University Medical Center (Chicago, IL)
- …Home Infusion Solutions (HIS). This includes collection of patient data, processing prior authorizations , and the reimbursement components of HIS. Provide prompt ... or other healthcare profession. *1 year experience with PBM & Major medical prior authorizations *Demonstrates basic knowledge of all technical skills associated… more
- Highmark Health (Harrisburg, PA)
- …job responsibilities. + Obtains or ensures acquisition of appropriate pre-certification authorizations from third party payers and placement to appropriate level of ... care prior to hospitalization utilizing medical necessity criteria and third...guidelines. Obtains or facilitates acquisitions of urgent / emergent authorizations , continued stay authorizations and authorizations… more
- CareOregon (Portland, OR)
- …subject matter expert for Pharmacy Benefit Specialists with questions regarding benefits, claims, prior authorizations , and appeals . + Respond to escalated ... Arizona, Nevada, Texas, Montana, or Wisconsin. Position Title: Pharmacy Benefit Coordinator II Exemption Status: Exempt Department: Pharmacy Title of Manager:… more
- Blue Cross and Blue Shield of Louisiana (Baton Rouge, LA)
- …Administration, Utilization Review Nursing Staff, Medical Directors, Medical Necessity Appeals , Administrative Appeals , Pharmacy and Providers staff. ... work preferred **Work Experience** + 1 year call center experience or prior knowledge of a health insurance pre-service authorization required **Skills and… more
- Cardinal Health (Topeka, KS)
- …the patient population + Follow through on all benefit investigation rejections, including Prior Authorizations , Appeals , etc. All avenues to obtain coverage ... Medical Claims billing and Coding work experience + 1-2 years' experience with Prior Authorization and Appeal submissions + Ability to work with high volume… more