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The prior authorization specialist will contribute to the development of a standardized prior authorization process across the organization with initiative and autonomy. The prior authorization specialist is responsible for coordinating all aspects of the prior authorization process, including insurance and benefit verification, gathering necessary clinical information to ensure reimbursement requirements are met, and communicating with key stakeholders (providers, insurance co., and patients.
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Title: Prior Authorization Specialist. Obtains clinical information (including but not limited to medical history, relevant labs and diagnostic testing) necessary to complete the Prior Authorization.
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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.
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The Prior Authorization Specialist is responsible for the timely submission of all documentation, forms, or electronic requests in a timely fashion to not impede our community's access to care.
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This includes adherence to the department's policies and procedures related to the verification of eligibility/benefits, pre-authorization requirements, available payment options, financial counseling and other identified financial clearance related duties.
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The Prior Authorization Specialist supports the admissions department's activities in the pre-admission, admission and follow up processes. A Prior Authorization Specialist should have some knowledge, skills and abilities in order to properly do his or her job.
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As a Prior Authorization Specialist at our dermatology practice, you will play a critical role in ensuring that our patients receive timely and appropriate approval for medical treatments, procedures, and medications.
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The FRM is responsible for providing access and reimbursement education to HCP office personnel including medical policies, prior authorization requirements, coding and billing, product access via buy-bill or specialty pharmacy and site of care options and restrictions with the goal of minimizing barriers to therapy.
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This position routinely works with physicians, clinic support staff, case managers, nurses, insurance utilization management staff, and patients to initiate pre-authorization and resolve issues that arise during the prior authorizations process.
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Coordinate any changes or modifications to hardware, software, or firmware of a system with the ISSM and Authorizing Official (AO) or Delegated Authorizing Official (DAO) prior to the change. The IA Analyst will serve as the Information Systems Security Officer (ISSO) and will be required to develop and update the authorization documentation and implementing configuration management across authorization boundaries.
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Notify ISSM when changes occur that might affect the authorization determination of the information system(s) Conduct periodic reviews of information systems to ensure compliance with the security authorization package.
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Provide coverage recommendations for medications subject to prior authorization, appeals, retrospective claim reviews, and audits based on applicable medication coverage policies, member benefit contracts, and provider contracts.
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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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TWC is not considering applications from persons who require immediate or future sponsorship for an employment visa to maintain work authorization eligibility. You must be a Texas resident to work for the Texas Workforce Commission or willing to relocate to Texas.
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Prior medical spa experience is a plus but not required. Familiar with PRP Hair Restoration injections. dr LASER LA is looking to hire an Aesthetic Registered Nurse to add to our team! Injector experience - Botox & Filler (a plus.
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prior authorization jobs Title: pharmacy technician Company: Genoa Healthcare Company
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