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May provide back-up pre-certification/prior authorization resources for other departments as needed. Develops and maintains reference manuals that outline the individual payer requirements as it relates to pre-certification and pre-authorization needs.
$17.15 - $21.44Full-timeExpandApply NowActive JobUpdated Today - UpvoteDownvoteShare Job
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The Prior Authorization Coordinator is responsible for striving to complete either approval for pharmacy claims requiring prior authorization or by coordinating with prescribers and or facility contact to have therapy changed to a preferred alternative due to insurance not covering the treatment in question.
$15.25 an hourFull-timeExpandUpdated 17 days ago - UpvoteDownvoteShare Job
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We are looking for candidates with prior experience in phase unbalanced power distribution systems and microgrid modeling, simulation, optimization, and/or analysis. Receipt of a Q clearance and additional access authorization ultimately is a decision of the Federal Government and not of Triad.
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Working in a fast-paced, high volume, dynamic environment, the Clinical Authorization Specialist will bring clinical expertise to the prior authorization and appeals processes and serve as a liaison and patient advocate between Dana Farber Cancer Institute and various health plans.
InternExpandApply NowActive JobUpdated 6 days ago - UpvoteDownvoteShare Job
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Responsible for obtaining, from Clinical Reviewer, insurance pre-authorization or referral approval codes prior to each treatment. Prior to a patient receiving treatment; obtains insurance coverage information and demographics; educates patient on insurance coverage, benefits, co-pays, deductibles, and out-of-pocket expenses.
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In-depth knowledge of Prior Authorization or Referrals. Experience navigating commercial insurance portals such as United Healthcare, Availity, and Navinet in the submitting, review and management of prior authorizations and referrals.
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Verifies pre-authorization requirements and follows up with both the referring physician and payer to ensure authorizations are on file for the scheduled procedure prior to date of service.
Full-timeExpandUpdated 16 days ago - UpvoteDownvoteShare Job
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The Field Reimbursement Manager (FRM) will be the field subject matter expert relating to patient support, access, reimbursement, prior authorization, appeal, financial assistance, and other business related issues within the Dupixent Business Unit.
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Support field in education of office personnel on prior authorization and appeals processes, reimbursement support through Dupixent MyWay, free drug programs and financial assistance programs.
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Position Title: Field Reimbursement Manager (FRM), Dupixent. The FRM is a critical front-line member of the Sanofi Genzyme Patient Support Services organization and will work across multiple internal stakeholders, Sales Teams, Market Access, Account Directors, Trade, Dupixent MyWay (Patient Support Program) and program vendors to deliver an exceptional customer experience.
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As a FRM, your duties will include but are not limited to Prior Authorization assistance, Claims Assistance, and Appeals and educating the office on Payer landscape. Educate on Benefit Investigation, Prior Authorization Process, Support Center Services, Medicare and Commercial coverage and patient communication streams.
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Minimum 7+ years' experience in the pharmaceutical/healthcare industry, Specialty Biologics and / or Market Access a plus. Establish and maintain knowledge on the local and national payer landscape, including Specialty Pharmacy and Utilization Management criteria for Dupixent.
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Experience in the healthcare industry including, but not limited to insurance verification, prior authorizations, and/or claim adjudication, billing and coding. The Field Reimbursement Manager (FRM) is responsible for managing an assigned territory focused on supporting access, Reimbursement and Patient services by providing assistance with patient reimbursement processes for VYVGART and our future argenx portfolio.
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The Field Reimbursement Manager works independently in a fast paced, highly visible environment as well as collaboratively with the internal program hub support services to ensure all customer needs are met.
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FRM will collaborate regularly with case manager and case coordinator on average of 4 x month and ad hoc as needed for escalations, these interactions are tracked in FRM CRM and hub system. Reimbursement Support on Case management, billing and coding updates, appropriate claims submission, Specialty Pharmacy, Medical Benefit Interpretation, understanding medical necessity, claims and appeal assistance, information related to co-pay assistance and patient assistance programs.
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