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The Pre-Certification Specialist is responsible for processing referrals for services and obtaining needed authorizations from the patient’s payor source. A Pre-Certification Specialist is responsible for collecting all information needed, to properly notify and obtain authorizations from all of the patient’s payor sources and be able to effectively communicate.
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Resolves all outstanding Alerts on pending appointments within 48 hours of the scheduled appointment to minimally include: Missing Referral Missing Pre-certification/Authorization Self Pay Accounts Eligibility Verification Missing Demographic/Insurance Information.
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Ensures that pre-certification and/or authorization and referral requirements have been completed by placing phone calls to insurance companies, physician offices, patients, and utilizing web based applications and/or internet resources; obtains clinical information from physician offices and/or Bryan system; contacts Health Information Management to obtain CPT and/or ICD-9 codes.
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The Referral Specialist is responsible for the pre-authorization functionality. Generate communication to the appropriate personal on new and revised documents including Prescriptions and Pre-authorization request.
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You will oversee utilization management process including verification of insurance coverage, pre-authorization, resource management and overall management of patients within the continued stay criteria.
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Relevant degree in healthcare preferred 3-4 years of experience in an infusion environment as a prior authorization specialist Knowledge of third-party payers and insurance and billing practices for infusion of pharmaceutical products.
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RN – Pre-Op Registered Nurse - Health Advocates Network is urgently hiring Pre-Op RNs with at least 2 years of recent experience! Posted job title: RN - Pre-Op. Specialty: Pre-Op Registered Nurse (RN.
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By solving challenges, providing the best placements, and advocating for you, we stand to help you thrive and pave the path forward in your career. Health Advocates Network-Nursing is seeking a travel nurse RN Preoperative for a travel nursing job in Webster, Texas.
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Notify parents of the need for completed insurance referral form or pre-authorization prior to scheduled/unscheduled appointments. Verify insurance information is complete prior to procedure and collect and verify pre-authorization/referral information: goal is to obtain authorizations 5 days in advance of service.
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Works with the Executive Director on revenue enhancements and process improvement projects and facilitates the resolution of complex issues impacting compliance, revenue and daily front end processes within the Mass General Brigham and Faulkner Prior Authorization Team and Denials and Appeals Departments.
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Review clinical documentation and submit to insurance companies for initiation and obtaining authorization or pre-certification on OP diagnostic hospital services. Work closely with the physician office staff to ensure that pre-cert/authorization numbers are entered in the scheduling or registration system.
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Serve as a resource to territory's accounts and JJIM staffregardinglocal, regional and national payer policies; reimbursement regulations and processes (i.e., eligibility and benefit verification, pre-authorization, billing, coding, claims, and appeals/grievances); practice management; Medicare and Medicaid rules and regulations; OSHA; HIPAA; and state-specific clinical staff licensing / certification requirements for product compounding, admixture, administration and monitoring.
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The Pre-K Assistant Teacher will play an integral role in the success of our center by serving as a positive role model as well as creating meaningful relationships and being a supportive resource for our students, families and their team.
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Senior Associate Scientist, Cell Culture Process Development - Pre-Pivotal Biologics CMC Development – Foster City, CA. The Senior Associate Scientist, Cell Culture Process Development (Pre-Pivotal) will lead and execute cell culture process development laboratory experimentation for Gilead biologics entities during pre-pivotal phases development (pre-clinical, phase I/II.
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Identifies all patients requiring pre-certification or pre-authorization at the time services are requested or when notified by another hospital or clinic department. Responsible for securing patient data based upon comprehensive data elements, financial education/counseling, insurance verification, provision of clinical information for pre-certification, authorization and third party claims management.
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pre authorization jobs Title: clinician Company: Tenet Call Center Ops in Forest-lake, Minnesota
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