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Manage 1915 Waiver funds ensuring prior authorization and ODM approval is obtained. Expected Starting Salary Range: - REPRESENTATIVE RESPONSIBILITIESThe BH Care Coordination Specialists will utilize high fidelity wrap around model and/or principals to provide community-based care coordination for children and families who are experiencing serious emotional disturbance (SED), trauma, cooccurring behavioral health disorders who are engaged with one or more child-serving systems (, child welfare, intellectual and developmental disabilities, juvenile justice, education) experience.
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The associate is responsible for obtaining prior authorization requests and/or pre-determination for these services to ensure maximum reimbursement to the organization. Ensures authorization has been obtained for all scheduled and non-scheduled high dollar outpatient procedures.
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Obtaining prior authorization guarantees Atrius Health can bill accurately for services where medication was administered in a timely manner. Reporting to and working under the general direction of the Supervisor(s) and Manager of the department, research patients' individual medical benefits to ensure prior authorization is obtained before patients' medical services are provided.
Full-timeRemoteExpandApply NowActive JobUpdated 5 days ago - UpvoteDownvoteShare Job
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Conducts prior authorization reviews to determine financial responsibility for Molina Healthcare and its members. This role will be doing prior authorization outpatient request for VA Medicaid members.
$51.49 an hourFull-timeExpandUpdated 8 days ago - UpvoteDownvoteShare Job
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Review claims for appropriate prior authorization/pre-certification of services, required information, and request additional details as needed. Review claims for appropriate prior authorization/pre-certification of services, required information, and request additional details as needed.
RemoteExpandApply NowActive JobUpdated 10 days ago - UpvoteDownvoteShare Job
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Uses prior experience and on-the-job training to solve straightforward tasks. If applicable, final offers will be contingent on ability to obtain authorization for access to U.S. export-controlled information from the U.S. Government.
Full-timeExpandUpdated 13 days ago - UpvoteDownvoteShare Job
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Basic understanding of information security and technology terms, concepts, and applications through relevant coursework or projects in network security, access and authorization, security risk management, cloud computing, fundamentals of cryptography, or development coding course (i.e., Python or similar.
$83,710 a yearFull-timeExpandApply NowActive JobUpdated 13 days ago - UpvoteDownvoteShare Job
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Conduct prior authorization and utilization management activities including adverse determinations. Requires 3 to 5 years prior experience as a CMO or Associate Medical Director preferably for a Medicare, MMP, or Medicaid plan inclusive of dually eligible enrollees.
Part-timeExpandApply NowActive JobUpdated 14 days ago - UpvoteDownvoteShare Job
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The Clinical Review Nurse I is responsible for reviewing and making medical determinations as to whether a prior authorization request meets the benefits the member carries. Prior experience with claim review of Medicare helpful.
$95,880 a yearFull-timeExpandApply NowActive JobUpdated Today - UpvoteDownvoteShare Job
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Serve as a resource/consultant to customers and staff regarding payer policies and processes (i.e., eligibility and benefit verification, prior-authorization, and appeals/denials) Serve as a resource/consultant to customers and staff regarding payer policies and processes (i.e., eligibility and benefit verification, prior-authorization, and appeals/denials.
$150,000 a yearFull-timeExpandApply NowActive JobUpdated 29 days ago - UpvoteDownvoteShare Job
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Maintains subject matter expertise pertaining to all external billing practices including but not limited to third party adjudications, prior authorization, and patient financial assistance programs in order to coach pharmacy technicians and other support staff.
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Review claims for appropriate prior authorization/pre-certification of services. Review claims for appropriate prior authorization/pre-certification of services. Ability to read and interpret contracts, and standard reference materials (PDR, CPT, ICD-9, ICD-10, and HCPCS.
Full-timeRemoteExpandApply NowActive JobUpdated 1 month ago - UpvoteDownvoteShare Job
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About: Utilization review uses managed care techniques such as prior authorization that allow payers, particularly health insurance companies to manage the cost of health care benefits by assessing its appropriateness before it is provided using evidence-based criteria or guidelines.
$24 an hourFull-timeRemoteExpandUpdated 28 days ago - UpvoteDownvoteShare Job
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Minimum 7+ years of transport category aircraft maintenance experience (Boeing series aircraft – preferred) 737,777 747-400, 747-800 Gen Fam with RII authorization. Ensure that all aircraft documentation is completed accurately per company and FAA procedures prior to aircraft departure.
$119,000 a yearFull-timeExpandApply NowActive JobUpdated 14 days ago - UpvoteDownvoteShare Job
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The prior authorization specialist is responsible for coordinating all aspects of the prior authorization process, including insurance verification, formulary reviews, gathering necessary clinical information from electronic medical record, and timely communication with patients, prescribers and physician office staff.
Full-timeExpandApply NowActive JobUpdated 1 month ago
prior authorization jobs in Cincinnati, OH
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