Current jobs related to Prior Authorization - Earth City - Optime Care
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Prior Authorization and Appeals Specialist
2 days ago
Earth City, Missouri, United States Optime Care Full timeJob SummaryOptime Care is seeking a highly skilled and detail-oriented Prior Authorization and Appeals Specialist to join our team. As a Prior Authorization and Appeals Specialist, you will play a critical role in managing the process of receiving, researching, and resolving Prior Authorizations and Appeals issues with health insurance companies.Key...
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Prior Authorization
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Earth City, United States Optime Care Full timeJob DescriptionJob DescriptionWhat we are looking forOptime Care is seeking a Prior Authorization and Appeals Specialist. We are looking for someone who is passionate about helping people get the specialized therapies they need. This critical role manages the process of receiving, researching, and resolving Prior Authorizations and Appeals issues with health...
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Oklahoma City, United States A-Line Staffing Solutions Full timeJob DescriptionJob DescriptionA-Line Staffing is now hiring Prior Authorization Pharmacist in remote. The Prior Authorization Pharmacist would be working for a Fortune 500 company and has career growth potential. This would be full time / 40+ hours per week.If you are interested in this prior authorization pharmacist position, please apply to this posting....
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Prior Authorization Specialist
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Prior Authorization Specialist
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new york city, United States Tandym Group Full timeA Health Care Start-up is seeking a Prior Authorization Specialist based in NYC.Worksite Setting: On-site office, but may switch to remote/hybrid down the road.Worksite location(s): SoHo NYCSchedule: Full time day flexible, minimum 20 hrs/week (weekdays only)JOB Description:Start Date: ImmediateKey Responsibilities* Complete prior authorization requests...
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Prior Authorization Specialist
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Clinical Review Nurse
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Kansas City, United States Spectraforce Technologies Full timeJob Title: Clinical Review Nurse - Prior Authorization Duration: 05 Months (Possible extension) Location: Remote - MO Monday - Friday (8 hours)Walk me through the day-to-day responsibilities of this the role and a description of the project (Outside of Workday JD): Reviewing authorization requests Utilizing evidence-based criteria and making a medically...
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Clinical Pharmacist
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Oklahoma City, Oklahoma, United States National Health Care Solutions Full timeAbout the RoleWe are seeking a highly skilled Clinical Pharmacist to join our team at National Health Care Solutions. As a Clinical Pharmacist - Prior Authorization Specialist, you will play a critical role in ensuring the accuracy and efficiency of our prior authorization process.Key ResponsibilitiesDocument Review and Management: Review, create, and...
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Prior Authorization Clinical Pharmacist
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Clinical Prior Authorization Technician
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Iowa City, United States University of Iowa Full timeThe Department of Pharmaceutical Care is seeking a full-time Prior Authorization Revenue Cycle Representative to join our team. The Pharmacy Prior Authorization Revenue Cycle Representative works to support patients in obtaining insurance coverage fo Authorization, Revenue, Cycle, Representative, Pharmacy, Pharmacy Technician, Healthcare
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Iowa City, United States The University Of Iowa Full timeThe Department of Pharmaceutical Care is seeking a full-time Prior Authorization Revenue Cycle Representative to join our team. The Pharmacy Prior Authorization Revenue Cycle Representative works to support patients in obtaining insurance coverage for outpatient pharmacy medications. The position will primarily focus on performing benefits investigations,...
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Iowa City, United States The University Of Iowa Full timeThe Department of Pharmaceutical Care is seeking a full-time Prior Authorization Revenue Cycle Representative to join our team. The Pharmacy Prior Authorization Revenue Cycle Representative works to support patients in obtaining insurance coverage for outpatient pharmacy medications. The position will primarily focus on performing benefits investigations,...
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Authorization Coordinator
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Oklahoma City, Oklahoma, United States BrightSpring Health Services Full timeCompany OverviewBrightSpring Health ServicesPosition SummaryJoin our dedicated team at BrightSpring Health Services, a premier provider of specialty healthcare solutions committed to delivering complex pharmaceutical products and clinical services to patients in a home setting. As a recognized leader in the specialty healthcare sector, we support numerous...
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Healthcare Authorization Representative
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Missouri City, Missouri, United States BCforward Full timeAuthorization Specialist Company Overview: BC Forward is seeking an Authorization Specialist to join our remote team. Position Title: Authorization Specialist Location: Remote Contract Duration: 3+ months with potential for hire Work Schedule: Sunday - Friday, 12:00pm - 8:30pm CST Compensation: $17.00/hr. on W2 Role Overview: The Authorization Specialist...
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Pharmacy Authorization Specialist
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Iowa City, Iowa, United States University of Iowa Full timePosition OverviewThe University of Iowa is looking for a dedicated Pharmacy Prior Authorization Revenue Cycle Representative to enhance our Pharmaceutical Care Department. This role is crucial in assisting patients with securing insurance approval for their medications.Key ResponsibilitiesFacilitate the prior authorization process for pharmacy...
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Authorization Representative
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Salt Lake City, United States Harmony Home Health & Hospice Full timeJob DescriptionJob DescriptionBenefits:401(k)Dental insuranceHealth insurancePaid time offVision insuranceCompetitive salaryTuition assistanceMaking a Difference: Its What We Do.At Harmony Home Health and Hospice, our mission is to make a difference in the lives of those we serve, every single day. As a family-owned and growing organization since 1997, with...
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Clinical Authorization Specialist
2 days ago
Oklahoma City, Oklahoma, United States National Health Care Solutions Full timeJob Summary:We are seeking a highly skilled and detail-oriented Clinical Authorization Specialist to join our team at National Health Care Solutions. As a Clinical Authorization Specialist, you will play a critical role in ensuring the efficient and effective processing of prior authorizations for medications.Key Responsibilities:Approve, dismiss, or...
Prior Authorization
2 months ago
What we are looking for
Optime Care is seeking a Prior Authorization and Appeals Specialist. We are looking for someone who is passionate about helping people get the specialized therapies they need. This critical role manages the process of receiving, researching, and resolving Prior Authorizations and Appeals issues with health insurance companies, including any escalated step of the appeals process.
What the position will be doing
- Ensure prior authorizations and appeals cases follow current CMS guidelines and timeliness criteria which includes communicating directly with providers and insurance companies.
- Prepare case files for Independent Review Entities or other levels of the Appeals process.
- Document all activities of the Prior Authorizations and Appeals process.
- Compose technical denial arguments for reconsideration.
- Overcome objections that prevent payment of claims and gain commitment for payment through concise and effective appeal argument.
- Identify problem payors, processes, and trends and escalating where appropriate.
- Utilize documentation standards that support a strong historical record of actions taken
- Write and complete final editing of letters of determination sent out for appeals.
- Produce and manage inbound and outbound correspondence in a manner that meets required timeframes.
- Prepare case files for Independent Review Entities or other levels of the Appeals process.
- Assist with internal and external audit processes.
- Proactively identifies areas of improvement for self and the department.
- Work with assigned clients to assess trends around payer responses.
- Participate in the development and completion of individual and departmental initiatives.
- Other duties as needed or assigned.
Necessary Skills, Education & Abilities
- High school diploma, or equivalent, required.
- 2 or more years of experience with medical/pharmacy insurance verification including benefit investigation.
- Current Missouri BOP Pharmacy Technician license, or Nurse license in good standing.
- Knowledge of prior authorizations and claim appeals.
- Medical terminology required.
- Knowledge of medical/pharmacy insurance benefit language; ie. EOBs, deductibles, Out of pocket, coinsurance, co-pays, etc.
- Ability to work independently, with limited supervision.
- Effectively meet established productivity, schedule adherence, and quality standards
- Ability to define CMS 1500s, provider numbers, CPT, HCPC’s, ICD9, NCPDP and NDC codes/numbers
- Ability to utilize critical thinking skills to identify issues and required actions within an appeal
- Computer literate and proficient with Microsoft Office
- Ability to participate in and facilitate group meetings
- Ability to thrive in a fast-paced environment with constantly changing and competing priorities.
- Excellent analytical skills and the ability to provide solutions to complex problems.
- Ability to be highly transparent, ethical, and driven. Relentless attention to detail, and the ability to be a creative self-starter and team player.
- Excellent written and verbal communication skills, and interpersonal skills required.
- Willingness to work a flexible schedule
About us
Optime Care is a Specialty Pharmacy dedicated to providing services to smaller patient communities. We focus on securing insurance coverage, coordinating care, and complying with therapy regimens are only a few examples. Our mission is to minimize the daily impact of living with unique disorders. After just one call, our experts begin to address everything from medication delivery and insurance reimbursement to compliance and education. Every patient receives a proactive service experience tailored to their specific needs.
What sets us apart
· Our focus on people- our customers, partners, and coworkers
· A company culture that embraces going beyond expectations in everything we do
· A leader in providing specialty pharmaceuticals to individuals with unique conditions
· An opportunity to learn from some of the best in the business
· A diverse and inclusive culture that embraces innovation
Optime Care provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state, or local laws.
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