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Insurance verification and pre-authorization. Insurance verification and pre-authorization. Our centers host a wide range of free educational events, screenings and seminars and offer programming to local schools and colleges, libraries, community organizations, youth centers, sports and recreation leagues, and other groups.
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Responsible for the clinical evaluation for coverage determination requests for prior authorization (PA) or other utilization management (UM) programs, including quantity limits, step therapy, formulary exception and tier exception; this includes consideration of the denial language and appropriateness of the decision as it pertains to the clinical content of the case and the intent of the individual client's pre-approved criteria.
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Complete pre-authorization, initial authorization and concurrent reviews as needed by each insurance payor (outpatient services) to ensure behavioral health services are authorized.
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This includes Prior Authorization / Pre Certification / Concurrent Reviews / Peer to Peer Calls / First Level Appeals / Special Projects and Committee participation when needed. This includes Prior Authorization / Pre Certification / Concurrent Reviews / Peer to Peer Calls / First Level Appeals / Special Projects and Committee participation when needed.
$169,000 - $364,000 a yearFull-timeExpandApply NowActive JobUpdated Today - UpvoteDownvoteShare Job
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The responsibilities of this position would also include pre-authorization process and acting as a liaison between the providers and patient. The responsibilities of this position would also include pre-authorization process and acting as a liaison between the providers and patient.
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Pre-registration prior to date of visit to ensure prior authorization for treatment. Coordinate with Infusion Clinical Nurse Manager for same day add-ons for sick or urgent patients and for transitions from inpatient, transplant alert the authorization team.
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Training and/or familiarity with Dialectical Behavioral Therapy (DBT), familiarity with abuse and neglect reporting and duty-to-warn mandates, knowledge of community-based resources and experience with pre-authorization and billing processes is preferred.
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Occasionally support related services such as pre-registration and prior authorization. Dependent Care Flexible Spending Account : Take advantage of pre-tax dollars to cover eligible dependent care expenses.
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Send Visco Injection authorization request to supplement pre-certification representative. Completes pre-certifications for MRI's, injectable, and other Physician orders as necessary.
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Communicate to the clinic about pre-authorization requirements and any updates. Inform patients on any prior authorization approvals or denials and the next step. 3+ years of healthcare front reception verification of benefits, prior authorization, and/or financial navigation experience in a fast-paced, customer-focused environment.
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You will participate in the development, implementation, and evaluation of clinical / medical programs and expand Aetna's medical management programs to address member needs across the continuum of care.
$169,000 - $364,000 a yearRemoteExpandApply NowActive JobUpdated Today - UpvoteDownvoteShare Job
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In the outpatient setting, support staff include a registration representative and pre-certification specialist to manage scheduling and prior authorization needs, and a medical assistant who helps triage patient calls and coordinate communication with families.
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The Utilization Review Specialist will also perform pre-certification reviews, concurrent reviews and will perform appeal reviews as needed. Job Overview: The Utilization Review Specialist is responsible for all aspects of the authorization of treatment via insurance and managed care companies.
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Insure completion of pre-authorization process by inquiry and referral to clinician. Perform tasks consistent with authorization and billing requirements. Resolve issues with payment and billing, authorization process.
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Responsible for the complete and accurate processing of appointment scheduling, pre-registration, insurance verification, and pre-authorization. Responsible for the complete and accurate processing of appointment scheduling, pre-registration, insurance verification, and pre-authorization.
$16.45 - $19.47 an hourFull-timeExpandUpdated Yesterday
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