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For North Carolina LTSS:Experience to include 2+ years of prior LTSS and/or HCBS coordination, care delivery monitoring and care management experience. Licenses/Certifications:Licensed Clinical Social Worker (LCSW), Licensed Marriage & Family Therapist (LMFT), Licensed Behavioral Health Medical Practitioner, Licensed Professional Counselor, Licensed Substance Abuse Counselor, Licensed Psychologist, or Registered Nurse preferred.
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Superior Health Plan STAR + Plus is expanding across Texas in over 100 counties throughout Austin, Corpus Christi, Dallas, Lubbock, and McAllen
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Collaborate with practices to facilitate redesign efforts, support care teams, introduce population health management and support achievement towards improved financial, process and clinical outcomes.
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Covenant Physician Partners is hiring for a Fulltime Prior Authorization Specialist to join our team at De La Pena Eye Group located in Commerce, California. The primary function of the Prior Authorization Specialist position is to provide premier customer service to the patient, physician and their office staff by obtaining facility authorizations for patient(s) scheduled.
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The Prior Authorization Specialist (PAS) is an essential role responsible for facilitating exceptional patient experience, by securing authorizations for all scheduled services related to medical and surgical admissions across entities, including BWH OR procedures, BWFH OR procedures, FXB OR procedures and BWH/BWFH Endoscopy Suite procedures in accordance with standards established by the Department, Hospital, Medical Staff, and outside regulatory and accreditation agencies.
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Schedules doctor appointments on behalf of the practitioner and assists member with wraparound services such as arranging transportation, connecting them with community-based resources and other affinity programs as available.
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Job DescriptionJob DescriptionPosition Overview: We are seeking a detail-oriented and experienced Prior Authorization Specialist to join our team. Minimum of 2 years of experience working as a Prior Authorization Specialist in a pharmacy or healthcare setting.
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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.
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You could be the one who changes everything for our 28 million members as a clinical professional on our Medical Management/Health Services team.
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2 to 5 years prior experience in managed care, sales, customer service or related experience preferred. In-depth knowledge of all Fidelis Care products, including “metal” products offered through the New York State of Health (NYSOH), Medicaid Managed Care, Child Health Plus, Medicare, MLTC, FIDA and HARP. Ability to answer product feature and benefit questions; compare and contrast Fidelis Care products and provider network of competing plans in assigned territory.
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Position Purpose Responsible for members gaining access to needed services through coordination and integration of medical and long term care services for the purpose of orientation, care plan development, assessment, and care coordination.
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Maintains a daily workflow of Ontrac work lists and keeps Epic auth/cert fields and notes updated prior to, throughout, and post service until case is in final secured status and authorization is complete for billing purposes.
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Compares system report of unbilled claims requiring prior approval to QuickBase tracking system to ensure any claim requiring prior authorization is being followed up on. Ensure accurate and timely completion of client prior authorization and/or change of therapy paperwork by collaborating with prescribers and facility contacts.
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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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The Prior Authorization Specialist (PAS) is an essential role responsible for facilitating exceptional patient experience, by securing authorizations for all scheduled services related to medical and surgical admissions across entities.
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Title: prior Company: Centene Corporation
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