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Prior Authorization Specialists Jobs

Supervisor, Prior Authorization Order Entry
By Natera At United States
Experience with insurance claims submission and management software.
Completes projects and reports in a timely fashion on a daily, weekly or monthly basis per the direction of management.
Demonstrated ability to develop and analyze payments, diagnose issues, and present findings to management.
Works with cross functional teams to manage the entire process from insurance verification to final collection of prior authorization.
Bachelor’s degree or equivalent experience. Degree in business administration, accountancy, sales, marketing, or similar preferred.
Minimum of 2 years directly related and progressively responsible experience.
Prior Authorization Technician Jobs
By Capital Rx At , Remote $45,000 - $55,000 a year
Experience handling prior authorization requests/understanding of prior authorization requirements required
2+ years of pharmacy technician experience in a PBM, health plan, or in another clinical pharmacy setting
Excellent communication, writing, and organizational skills
Ability to work independently with minimal supervision, stay productive in a remote, high-volume, metric driven call center environment
Prepare prior authorization requests received by validating prescriber and member information, level of review, and appropriate clinical guidelines
Review and analyze pharmacy claims data for proactive outreach and intervention.
Lvn / Lpn Care Review Clinician, Prior Authorization
By Molina Healthcare At , Long Beach, 90802 $21.82 - $42.55 an hour

Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

To all current Molina employees:

Care Review Clinician, Prior Authorization
By Molina Healthcare At , Long Beach, 90802 $52,199 - $101,788 a year

Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.*

To all current Molina employees:

Prior Authorization Pharmacy Technician
By SmithRx At , Remote
Organize and prioritize multiple requests internally and externally to ensure timely prior authorization case management.
Verify eligibility and drug coverage under the plan benefit design to determine appropriate claims processing
Use pharmacy technician experience to navigate drug products, formulations, and perform basic calculations to check and monitor accurate claims adjudication.
High School diploma or GED or equivalent work experience
2-4 years of experience as a Pharmacy Technician
2+ years of experience in prior authorization review (specifically working on the approval side at a PBM or health plan) required
Prior Authorization Nurse Reviewer
By Medical Mutual of Ohio At ,
Keeps up to date on utilization management regulations, policies and practices, including applicable coding.
Strong knowledge of health insurance benefits and network plan designs.
Knowledge of clinical practices, members’ specific health plan benefits, and efficient care delivery processes.
Acute care Medical/Surgical/Critical Care and ambulatory care experience preferred.
Knowledge of, and the ability to apply fundamental concepts related to HIPAA compliance and related regulations.
Ability to apply knowledge of health plans and industry trends to achieve positive outcomes.
Prior Authorization Coordinator Jobs
By Retina Utah MSO LLC At , Murray, 84107
Obtains authorizations from insurance companies and records notes accurately in the practice management system in a fast and efficient manner.
Provides immediate verification of benefits as needed for same or next day added-on patient appointments.
Must have knowledge of current insurance companies and electronic portals
Knowledge of billing procedures and collection techniques
Experience using medical billing software
Excellent verbal and written communication skills
Prior Authorization Coordinator Jobs
By Banner Health At , Sun City, 85351
Banner Sun Health Research Institute Sun City
new grads may be considered. Monday through Friday 8:30 am - 5:00 pm Day Shift.
Our organization supports a drug-free work environment.
Um Nurse (Outpatient Prior Authorization)
By Devoted Health At , Remote
A minimum of 3 years experience doing utilization management at a health plan.
Identifies documents and communicates potential quality assurance or risk management issues as appropriate.
Educate providers on utilization and medical management processes
Support and coach members to improve management of their chronic conditions, including medication adherence and compliance
A desire to make a change in the healthcare experience: you love to serve and make a difference.
A minimum of 4 years of RN experience.
Sr Prior Authorization Spclst
By Children's Minnesota At , $36,192 - $60,008 a year
Knowledge in governmental and commercial payors, medical billing requirements, and prior authorizations.
Knowledge of how prior authorization functions impact billing, clinical teams, the quality of care and the patient experience.
Post-secondary education in a related field preferred.
Three years' experience in a healthcare or related field.
Preferred experience: Three years' experience in medical billing/prior authorization/insurance.
Demonstrated knowledge of Prior Authorization operations and medical office and/or hospital procedures.
Prior Authorization Operations Supervisor
By Cochlear Ltd At , Lone Tree, 80124
Evaluate and adjust team member work and region assignments based on team member's knowledge, skill set and business need
Hybrid work environment with a combination of in-office and work from home
Bachelor's Degree or Equivalent Work Experience
1‐2+ years of leadership and/or coaching experience
Extensive knowledge of government insurance and commercial insurance
Lead and develop a team of 10+ reimbursement specialists
Prior Authorization Associate Jobs
By Lexington Medical Center At , West Columbia, 29169, Sc
Escalates difficult issues, problems, questions and process improvement suggestions to management.
Substitutable Education & Experience (Optional)
We are committed to offering quality, cost-effective benefits choices for our employees and their families:
Understands the referral process start to finish and acknowledges authorization as an important step in the overall process.
Day ONE medical, dental and life insurance benefits
Meets authorization volume and quality standards set monthly.
Manager, Prior Authorization Patient Support
By ABBVIE At , , Il

Experience working in market access, trade, and/or pharmacy channels strongly preferred.

Must have the ability to effectively collaborate with, motivate and influence various levels/grades cross-functionally within and outside the organization.

Prior Authorization Scheduler Jobs
By Infinx At United States
Maintain the strictest confidentiality in accordance with HIPAA regulations and clinic requirements.
Knowledge of Medical Terminology and ability to interpret clinical documentation
Excellent interpersonal and communication skills both written and orally.
At least 2 years of experience in a doctor’s office as a medical assistant.
At least 1+ years of experience in medical scheduling, preferably with Orthopedics, Cardiology, Imaging procedures.
Answers the telephone promptly in a courteous and professional manner.
Prior Authorization And Pre-Registration Manager
By IVX Health At Nashville Metropolitan Area, United States
Bachelors Degree in Healthcare Management or related field
Oversees intake and prior authorization team and process effectively with a focus on improving the centralized patient onboarding experience.
Manages department-related ad-hoc projects as needed.
Excellent communication and interpersonal skills
Extensive experience with patient intake, prior authorization and financial counseling preferred
Manager, Prior Authorization & Preregistration
Prior Authorization Pharmacy Technician
By LanceSoft, Inc. At United States
4. Effectively manage work volume by handling inbound calls/fax requests utilizing appropriate courteous and professional behavior based upon established standards.
Physical Requirements [ex. Sit, stand, stoop, bend and walk]
- Basic pharmaceutical knowledge pertaining to terminology, calculations, and protocols.
- Must possess excellent written, verbal, grammar, and listening communication skills.
Example: Lifts, scans and bags purchased items
1. Regular and predictable attendance
Prior Authorization/Scheduling Manager, Patient Access Servi
By South Georgia Medical Center At Valdosta, GA, United States
Experience in Business Management, Finance or Nursing is required.
Previous data entry, programming, office coordinator/management experience required.
Bachelor’s degree in healthcare, business, or a related field preferred or a high school diploma/GED with 3 years management experience.
Individual will possess an extensive background in personal computer applications.
Active membership in NAHAM preferred
Prior Authorization Specialists Jobs
By University of Missouri At , Columbia, Mo $16.23 - $28.25 an hour
Previous experiences RevCycle and/or Powerchart is preferred.
Know Your Rights English Version
Know Your Rights Spanish Version
The Thompson Center for Autism & Neurodevelopmental Disorders
University Title:BUSINESS SUPPORT SPECIALIST II
Internal applicants can determine their university title by accessing the Talent Profile tile in myHR.
Prior Authorization Specialists Jobs
By University of Missouri - Kansas City At , Kansas City, 64110, Mo $16.23 - $28.25 an hour
Previous experiences RevCycle and/or Powerchart is preferred.
Know Your Rights English Version
Know Your Rights Spanish Version
The Thompson Center for Autism & Neurodevelopmental Disorders
University Title:BUSINESS SUPPORT SPECIALIST II
Internal applicants can determine their university title by accessing the Talent Profile tile in myHR.