Prior Authorization

2 weeks ago

Huntington, United States OVP Health Care Full time
Job DescriptionJob DescriptionSalary:

DUTIES AND RESPONSIBILITIES:

  • Coordinates all referrals to specialist practices and local-regional healthcare services.
  • Process referral requests for patients for specialty services and diagnostic imaging.
  • Provide appropriate customer service and answer patient inquiries.
  • Maintain established tracking system of referrals--both external and internal.
  • Provide information and support to dental providers regarding patient referrals.
  • Uses sound judgment with patient scheduling efforts and utilization of resources.
  • Documents and traces interaction with clients and appointments, assisting with data entry.
  • Performs Prior Authorization for patients before scheduled procedures.
  • Perform other duties as may be delegated by the Chief Compliance Officer or designee.
  • Obtain current identification for managed care, prepare pre-certification as required including patient diagnosis as documented by primary care physician.
  • Make appointments and request follow-up information.
  • Review and explain process for referral to patient, including but not limited to what to expect, who providers are and how to get to hospital or referral specialist’s office.
  • Review rejected requests for procedures or visits.
  • Maintain up-to-date knowledge of referral guidelines, active providers, necessary coverage information, insurance requirements necessary for pre-certification.
  • Maintain adequate records for risk management on referrals completed of patients needing to be seen outside of API.
  • Compile monthly report for administrative review.
  • Mail, fax or communicate appropriate records, certificates and authorizations to appropriate persons for the completion of the referral process.

 

Minimum Qualifications

  •  General knowledge of the various Dental services in the Tri-State area.
  • Knowledge of medical terminology
  • Excellent organizational skills including oral and written communication skills. 
  • Ability to work independently; excellent interpersonal skills; basic computer skills. 
  • Ability to relate to people from a variety of socio-economic and ethnic backgrounds.
  • Prior medical/Dental office experience required with 1-3 years of related medical office and/or community experience considered.
  • Must be self-motivated and organized.
  • Previous referral experience preferred. 
  • Must be multi-tasked and complete duties with minimal supervision

  • Clinical Pharmacist

    1 week ago

    Huntington, United States Marshall Health Full time

    Job Responsibilities:Provides for safe and effective use of medications through comprehensive medication therapy management, consulting with members of the healthcare team and obtaining prior authorizations. Communicates with patients, clinicians and medical providers in a clear and concise manner. Prevents, detects, and resolves medication-related...

  • Clinical Pharmacist

    4 days ago

    Huntington, United States Marshall Health Full time

    Job Responsibilities:Provides for safe and effective use of medications through comprehensive medication therapy management, consulting with members of the healthcare team and obtaining prior authorizations. Communicates with patients, clinicians and medical providers in a clear and concise manner. Prevents, detects, and resolves medication-related...

  • Medical Policy Pharmacist

    6 days ago

    Huntington, WV, United States A-Line Staffing Solutions Full time

    Shift: Need 2 Pharmacists to work 7-4pm, possible weekends. Need 2 to work 1-11pm, possible weekends. Scheduled Pay: Bi-Weekly Benefits: Health, Dental, Vision, Life Insurance, and short-term disability after 90 days Provides pharmaceutical services to long term care and institutionalized patients in a manner that maximizes quality and patient safety....

  • Access Center Lead Agent- Call Center, Nassau, Long

    2 days ago

    Huntington, United States Mount Sinai Full time

    **Description** **Access Center Lead Agent - Greenlawn, Long Island - OFFS** **Strength Through Diversity** Ground breaking science. Advancing medicine. Healing made personal. **Job Title: Access Center Lead Agent** The Lead Agent for the Access Center is a senior level individual, responsible for scheduling appointments, consults and follow-up...

  • Remote Licensed Therapist

    1 week ago

    Huntington Beach, California, United States Anew Era TMS Full time

    Job Description The Therapist works in a dynamic multidisciplinary team providing treatment services according to the Professional Psychiatric Services under DBH. Therapist responsibilities include providing therapy services, leading therapy groups, facilitating clinical assessments, conducting individual sessions, and other tasks as detailed below. The...

  • Honeymoon Destination Planner

    4 days ago

    Huntington Station, United States Sail Away Travels Full time

    Are you passionate about creating unforgettable honeymoon experiences? Do you have a knack for crafting tailor-made adventures in romantic locales? We're seeking dedicated individuals with expertise in destinations and vacations to join our team. Our Team offers a unique opportunity to work remotely and design personalized honeymoon experiences that fulfill...

  • Principle Investigator

    4 weeks ago

    Huntington Park, United States Medix™ Full time

    Summary:The Principal Investigator responsibilities are centered around the execution, planning and management of assigned studies. Communicate succinctly with clients, study directors and technicians are key as is a cross-functional, flexible, and collaborative spirit. The Principal Investigator is responsible for the conduct of the clinical trial at a...

  • Principle Investigator

    4 weeks ago

    Huntington Park, United States Medix™ Full time

    Summary:The Principal Investigator responsibilities are centered around the execution, planning and management of assigned studies. Communicate succinctly with clients, study directors and technicians are key as is a cross-functional, flexible, and collaborative spirit. The Principal Investigator is responsible for the conduct of the clinical trial at a...

  • Principle Investigator

    4 weeks ago

    Huntington Park, United States Medix™ Full time

    Summary:The Principal Investigator responsibilities are centered around the execution, planning and management of assigned studies. Communicate succinctly with clients, study directors and technicians are key as is a cross-functional, flexible, and collaborative spirit. The Principal Investigator is responsible for the conduct of the clinical trial at a...

  • Collision Estimator

    2 weeks ago

    Huntington Beach, California, United States Caliber Full time

    Service CenterHuntington BeachAbout CaliberAt Caliber, our Purpose is Restoring the Rhythm of Your Life. We are looking for individuals that have a desire to Do the Right Thing and thrive in a purpose-driven, team-driven culture that supports you to reach your full potential. If this sounds like you, please join us About this Opportunity Provides World Class...

  • Client Success Associate

    2 weeks ago

    Huntington Beach, United States Valer Full time

    Our mission is to speed and simplify prior authorization management, enabling our clients to deliver faster, easier healthcare to their patients. Valer's technology automates submissions, status checking, verification, reporting, and EHR synchronization across all healthcare settings, specialties, and payers from one platform and portal.All built around each...

  • Client Success Associate

    2 weeks ago

    Huntington Beach, United States Valer Full time

    Job DescriptionJob DescriptionOur mission is to speed and simplify prior authorization management, enabling our clients to deliver faster, easier healthcare to their patients. Valer’s technology automates submissions, status checking, verification, reporting, and EHR synchronization across all healthcare settings, specialties, and payers from one platform...

  • Principle Investigator

    4 weeks ago

    Huntington Park, CA, United States Medix™ Full time

    Summary:The Principal Investigator responsibilities are centered around the execution, planning and management of assigned studies. Communicate succinctly with clients, study directors and technicians are key as is a cross-functional, flexible, and collaborative spirit. The Principal Investigator is responsible for the conduct of the clinical trial at a...