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Monitor work queues (through EPIC), work with insurance companies for predetermination and authorization, verifies patient insurance, monitors reports related to denials and other processes. Working knowledge of EPIC is preferred About Us CentraState Healthcare System, a partner of Atlantic Health System, is a fully accredited, not-for-profit, community-based health system that provides comprehensive health services in the central New Jersey region.
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Current licensure from the Texas Board of Nursing as an Advanced Practice Registered Nurse (APRN) with authorization to practice as a Clinical Nurse Specialist. -Current licensure from the Texas Board of Nursing as an Advanced Practice Registered Nurse (APRN) with authorization to practice as a Family, Adult, Gerontology, Adult-Gerontology Primary Care, Adult-Gerontology Acute Care, Acute Care Nurse Practitioner, Pediatric, Neonatal, Psychiatric Mental Health or Women's Health Nurse Practitioner.
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Support providers and reviewers with prior authorization requests for post-acute care services. Includes manually entering authorization requests into Care Management systems, following rules and algorithms embedded in the care management system to administratively approve prior authorization requests.
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5 years of experience developing ServiceNow CAM/IRM (Continuous Authorization and Monitoring / Integrated Risk Management) modules including good understanding of NIST Risk Management Framework, Risk and Audit processes in ServiceNow. ServiceNow Certified Application Developer (CAD) ServiceNow Certified Implementation Specialist – Risk and Compliance Excellent verbal and written communication skills Must be able to obtain and maintain a Public Trust.
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The Insurance Verification Authorization Specialist will assure authorization is obtained for all procedures and diagnostic testing to services being rendered. The Authorization Specialist will also initiate the authorization for direct admissions, emergency admissions, and emergency procedures.
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Communicates with insurance companies to expedite and/or manage delays with authorization for post-acute care and services. ·Identify and refer to community services, as indicated·Accesses and navigates the EMR to obtain essential information and documents CMRS progress notes and Resource Specialist Quick Notes per department standards.
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RCM Analyst | Revenue Cycle Credentialing Specialist | Insurance Specialist | Revenue Cycle Contracting Specialist | Medical Billing Specialist | Revenue Cycle AR Collections Specialist | Billing and Reimbursement Specialist | Billing Specialist |Billing Coordinator | Claims Specialist | Billing Representative | Collections Specialist | ABA Billing Specialist | ABA Claims Specialist | Behavioral Health Billing Specialist.
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We are seeking a friendly, empathetic and detail-oriented Authorization Coordinator to join our team at Parx Home Care. As a leading home care agency servicing Miami-Dade counties in Florida, our mission is to provide peace of mind to families knowing their loved ones are receiving the best care possible.
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Processes administrative and financial components of financial clearance including, validation of insurance/benefits, medical necessity validation, routine and complex pre-certification, prior-authorization, scheduling/pre-registration, patient benefit and cost estimates, as well as pre-collection of out of pocket cost share and financial assistance referrals.
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Process requests for authorization of payment of rent arrears to prevent participant’s eviction; suggest alternatives to maintain housing for public and non-public assistance individuals and families.
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Excellent communication and written skills HOW TO STAND OUT FROM THE CROWD (Desired Skills)Showcase your knowledge of modern development through the following experience or skills:ServiceNow Certified Implementation Specialist Risk and ComplianceNIST Risk Management Framework (RMF)Agile development processesSystem integration (SOAP, REST, Stored Procedures, Queues, etc.
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Utilizes Epic Referral Work Queues, Experian Real Time Authorization (RTA), phone, payer websites and fax to complete prior authorizations for imaging and specialty services. Duties & Responsibilities Partners with LMC departments and insurance companies to provide quality care to LMC patients through the authorization process prior to patients' date of service.
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Experience in the development of RMF Assessment and Authorization (A&A) Security Plans (SP), System Level Continuous Monitoring (SLCM), Ports, Protocols and Services Management (PPSM), Host Based Security Systems (HBSS), Assured Compliance Assessment Solution (ACAS) vulnerability scanning.
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Ensures all policies governing commercial pre-certification and authorization are followed to minimize financial risk. Obtains timely authorization of all patients requiring pre-certification and is accountable for conversion percentage and results.
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As a proud supplier to the US Department of Defense, you must have authorization to work in the U.S. and be eligible for any required government authorization per ITAR and EAR regulations.
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authorization specialist jobs Title: prior authorization Company: Partners Healthcare System
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