- 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
- 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 (Columbus, OH)
- …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
- University of Rochester (Rochester, NY)
- …care and follow up. Adheres to approved protocols for working referrals and prior authorizations . Makes decisions that are guided by protocols and practices ... providing multiple, complex details to insurance or worker's compensation carrier to obtain prior authorizations for both standard and complex requests such as… more
- University of Rochester (Rochester, NY)
- …care and follow up. Adheres to approved protocols for working referrals and prior authorizations . Makes decisions that are guided by protocols and practices ... providing multiple, complex details to insurance or worker's compensation carrier to obtain prior authorizations for both standard and complex requests such as… more
- University of Rochester (Rochester, NY)
- …care and follow up. Adheres to approved protocols for working referrals and prior authorizations . Makes decisions that are guided by protocols and practices ... providing multiple, complex details to insurance or worker's compensation carrier to obtain prior authorizations for both standard and complex requests such as… more
- University of Utah (Salt Lake City, UT)
- …and collection processes by verifying eligibility and benefits, obtaining pre- authorizations , entering medical codes, requesting payments and resolving account ... payment plans. 3. May contact insurance companies for explanation of benefits, pre- authorizations and to resolve claim issues. 4. Coordinates and resolves denials… more
- Fair Haven Community Health Care (New Haven, CT)
- …+ Schedule/treatment plan reviews for carrier authorization + Obtaining and logging prior authorizations for procedures as mandated by carriers. Collections ... Haven prides itself on efficient billing services including the filing of claims, appeals processing, authorizations , and, above all, a great passion for helping… more
- State of Colorado (CO)
- …basis. + Work as the statewide Uncrewed Aircraft System (UAS) Head Quarters Coordinator to plan, develop, and guide the UAS Program within CDOT. + Serve ... that this position currently supervises. + Process ROW plan authorizations per requests from CDOT regions working closely with...of the department's action. For more information about the appeals process, the official appeal form, and how to… more
- University of Michigan (Ann Arbor, MI)
- …insurance benefit investigations; completing specialty pharmacy prior authorizations (PAs); coordinating specialty prescription drug appeals ; coordinating ... FTE position is dedicated to 100% patient care as a pharmacy financial coordinator within the specialty pharmacy program. This position reports directly to the PFC… more
- Hackensack Meridian Health (Hackensack, NJ)
- …ortho calls, payer communications and support of the Care Coordinators. Prepares required Appeals and Denial information for processing and follows up on receipt of ... hour discharge report and providing patients with the IM Letter from Medicare prior to discharge. **Responsibilities** A day in the life of an Integrated Case… more
- University of Miami (Doral, FL)
- …physicians and clinic staff with filing charges, billing, and insurance authorizations including pre-authorization and retro-authorization and appeals as needed. ... patient informed consents, and preparing supplies. + Complete procedure booking sheets prior to procedure at the attending's direction and serve as liaison between… more
- University of Rochester (Rochester, NY)
- …for referrals. Develops, enforces and continuously improves the process for obtaining prior authorizations for office visits, skin testing and ancillary testing. ... provider preferences or availability. Works with Practice Manager, Fellowship Co- coordinator , and Clinical Directors to implement scheduling changes. Maintains and… more
- University of Miami (Miami, FL)
- …He/she will work alongside provider and nurses to complete specialty medication appeals , follow up with insurance and communicate with patient for outcomes. ... treatment, assessment or medical information in the patient medical record.* Obtain authorizations for all testing required for patients such as Ultrasounds, Chest… more