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Blue Ridge Health is currently seeking a Prior Authorization Specialist to be part of our Medical team in Polk County. The Prior Authorization Specialist collaborates with patients, internal staff, other medical center representatives, and third-party payers to facilitate the smooth exchange of information related to obtaining timely prior authorizations for pharmaceutical and imaging patient needs.
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Overview 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.
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The primary purpose of the Prior Authorization specialist is to communicate with the clinical staff, surgical schedulers, providers, and insurance companies to obtain authorizations and coordinate scheduling for upcoming procedures and/or surgeries for Firestone Ambulatory Surgery Center.
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The Authorization Coordinator is responsible for obtaining appropriate insurance pre-certification/preauthorization prior to the provision of scheduled infusion center services or treatments. He/she is accountable for pre-registering patients in Meditech, verifying insurance eligibility and obtaining authorization as needed from the payer, Additionally, he/she will be the primary on-site liaison in the Infusion Center for referring providers' offices, patient access staff, insurance carriers, as well as patients and other hospital staff regarding insurance pre-certification/preauthorization verification.
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Expert knowledge of the following policies and guidance: National Industrial Security Program Operating Manual (NISPOM), Joint SAP Implementation Guide (JSIG), Intelligence Community Directive (ICD) 503 and 705 and/or DCSA Assessment & Authorization Process Manual (DAAPM.
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The Prior Authorization Coordinator will collaborate with the Harbor Care and outside pharmacy's, Harbor Care providers, clinic staff, clients, commercial payers and other outside entities to coordinate care.
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Receipt of a Q clearance and additional access authorization ultimately is a decision of the Federal Government and not of Triad. Dependent upon the position, additional authorization to access classified information may be required, which may or may not be available to dual citizens.
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Coordinate with the billing and insurance teams to address any pre-authorization requirements. Previous experience in insurance eligibility verification and prior authorization within a medical setting, preferably in dermatology.
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Knowledge of Information System Security Manager (ISSM) and Information System Security Officer (ISSO) Roles and Responsibilities and the DoD assessment and authorization process. Must be able to lead the assessment of artifacts and guide the authorization of his or her systems to authorization ether independently or as a team.
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Advise the Information System Owner (ISO), Information Data Owner (IDO), Program Security Officer (PSO), and the Delegated and/or Authorizing Official (DAO/AO) on any assessment and authorization issues.
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Cummins will provide the Social Security Administration (SSA) and, if necessary, the Department of Homeland Security (DHS),with information from each new employee's Form I-9 to confirm work authorization.
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Payer Formularies and restrictive Utilization Management Criteria including: Prior Authorization Processes, Step Edits, Appeals, detailed Clinical Documentation, Peer to Peer reviews etc. Field Reimbursement Manager, Immunology Position Summary: The Field Access & Reimbursement environment for specialty biologics has proven to be highly challenging for HCPs and Patients.
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Reemployed Annuitants: Since the TSO position is permanent, it does not meet the eligibility requirement for a salary offset waiver under the National Defense Authorization Act (NDAA) for Fiscal Year 2010.
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For Therapist I-SUD and Therapist II-SUD: A SAC-IT, SAC, or CSAC required in WI. A substance abuse specialty authorization applicable in WI is required. · SAC-IT (SUD) certification is a bonus for Therapist I (in training) or Therapist II (fully licensed) positions.
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Requires dedicated and focused customer facing support through the Reimbursement Management Team. The Field Reimbursement Manager is a critical front-line member of the Regeneron Commercial and Field Reimbursement Management team.
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authorization job Title: signing bonus Company: Bradbury Brothers Cooling Heating Plumbing
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