PRIOR AUTHORIZATION SPECIALIST Innovation Care Partners

2 months ago


Scottsdale, United States HonorHealth Full time

Responsibilities Job Summary The Prior Authorization (PA) Specialist is responsible for the review of requests for authorization of services and coordinates the timely completion of the authorization process for Utilization Management Department. The PA Specialist will review referral and admission requests, verify eligibility, benefit information and determine whether sufficient clinical information has been submitted for review utilizing health plan, CMS, MCG or other nationally recognized criteria/guidelines, approves referrals and admission requests if criteria and guidelines are met. Receives referral and admission requests from practices and acute/post-acute facilities. Verifies patient's demographic and insurance information within billing system. Coordinates PA process in MCG software and ensures appropriate documentation for criteria is met. Approves request or sends request for the Medical Director/designee review if criteria and guidelines are not met. Maintain a productivity PA case load of an average of 10-15 prior auth processing per day. Requests additional information from medical office staff members and referring physicians as necessary Identifies potential risk /quality management cases using established criteria and refers to Director. Coordinates PA issues with organization’s Medical Director/Designee. Follows organizations PA policies and procedures. Maintains professional conduct and good working relationships with co-workers, supervisors and other provider practices. Maintains accurate logs of PA authorizations within software – date stamp all received documents sent to organization for processing. Obtains prior authorizations and referrals from practices in accordance with organization’s requirements using website and fax systems. Reviews medical records within IE and/or EPIC for appropriate submission to obtain authorizations. Qualifications Education High School Diploma or GED Required Experience 1 year health plan based prior authorization experience. Required

#J-18808-Ljbffr



  • Scottsdale, Arizona, United States HonorHealth Full time

    Overview: Are you looking to contribute to a significant cause? At HonorHealth, you will join a dedicated team focused on delivering a comprehensive care experience for our patients. You will have the chance to make a real impact through various initiatives and extensive training programs tailored to your professional growth. HonorHealth provides a...


  • Scottsdale, United States HonorHealth Full time

    Overview: Looking to be part of something more meaningful? At HonorHealth, youll be part of a team, creating a multi-dimensional care experience for our patients. Youll have opportunities to make a difference. From our Ambassador Movement to our robust training and development programs, you can select where and how you want to make an impact. HonorHealth...


  • Scottsdale, United States HonorHealth Full time

    Overview: Looking to be part of something more meaningful? At HonorHealth, youll be part of a team, creating a multi-dimensional care experience for our patients. Youll have opportunities to make a difference. From our Ambassador Movement to our robust training and development programs, you can select where and how you want to make an impact. HonorHealth...


  • Scottsdale, United States HonorHealth Full time

    Overview Looking to be part of something more meaningful? At HonorHealth, you'll be part of a team, creating a multi-dimensional care experience for our patients. You'll have opportunities to make a difference. From our Ambassador Movement to our robust training and development programs, you can select where and how you want to make an impact. HonorHealth...


  • Scottsdale, Arizona, United States HonorHealth Full time

    OverviewThe Infusion Clinic is dedicated to providing exceptional care and support to our patients. As part of our team, you will play a crucial role in enhancing the overall patient experience.At HonorHealth, we believe in creating a meaningful impact in healthcare. You will have the opportunity to contribute to our mission through various initiatives and...


  • Scottsdale, United States HonorHealth Full time

    OverviewLooking to be part of something more meaningful? At HonorHealth, you'll be part of a team, creating a multi-dimensional care experience for our patients. You'll have opportunities to make a difference. From our Ambassador Movement to our robust training and development programs, you can select where and how you want to make an impact.HonorHealth...


  • Scottsdale, Arizona, United States Plexus Worldwide Full time

    Join Our Team as a Product Innovation SpecialistPosition OverviewThe Product Innovation Specialist will spearhead the technical strategy for product development (including dietary supplements, functional foods, skincare, etc.) aimed at both domestic and international markets. This role collaborates closely with Product Marketing, Operations, and external...


  • Scottsdale, United States Innovative Health Care Full time

    Company Overview:Innovative Wound Solutions, a leading healthcare organization dedicated to providing innovative and patient-centered care, is seeking a highly motivated and experienced Nurse Practitioner to lead our newly established Wound Care Program. We are committed to delivering high-quality, personalized care to individuals with complex wounds, and we...


  • Scottsdale, United States HonorHealth Full time

    Overview Looking to be part of something more meaningful? At HonorHealth, you’ll be part of a team, creating a multi-dimensional care experience for our patients. You’ll have opportunities to make a difference. From our Ambassador Movement to our robust training and development programs, you can select where and how you want to make an impact....


  • Scottsdale, United States HonorHealth Full time

    OverviewLooking to be part of something more meaningful? At HonorHealth, you'll be part of a team, creating a multi-dimensional care experience for our patients. You'll have opportunities to make a difference. From our Ambassador Movement to our robust training and development programs, you can select where and how you want to make an impact. HonorHealth...


  • Scottsdale, Arizona, United States Absolutely Able Home Care Full time

    Position Overview: Front Office ReceptionistAbsolutely Able Home Care is seeking a dedicated front office receptionist to enhance our operational efficiency. While prior experience in a healthcare setting is advantageous, it is not a strict requirement. This role offers a commitment of over 35 hours per week, along with a comprehensive benefits package.Key...


  • Scottsdale, Arizona, United States Four Peaks Neurology Full time

    Job OverviewWe are looking for a Healthcare Support Specialist to join our organization. In this role, you will carry out essential administrative and clinical tasks to ensure the efficient operation of our medical facility.Key Responsibilities:Exhibit empathy towards patients while maintaining a high level of professionalism in interactions with healthcare...


  • Scottsdale, Arizona, United States Plexus Worldwide Full time

    Join Our Team as a Product Innovation ScientistAbout the RoleThe Product Innovation Scientist will spearhead the technical strategy for a diverse range of products including dietary supplements, functional foods, and skincare solutions aimed at both U.S. and international markets.This role involves close collaboration with Product Marketing, Operations, and...


  • Scottsdale, Arizona, United States Absolutely Able Home Care Full time

    Position Overview: Front Office ReceptionistWe are a dedicated Home Care agency seeking a reliable front office receptionist to enhance our operations. While prior experience in a healthcare setting is advantageous, it is not a strict requirement. This role provides over 35 hours of work weekly, along with available benefits.Key Responsibilities:Handle...


  • Scottsdale, Arizona, United States Western Veterinary Partners Full time

    As the demand for veterinary services continues to rise, Western Veterinary Partners is expanding its team and is eager to welcome a new Associate Veterinarian. We are in search of a dedicated DVM who is passionate about enhancing our veterinary offerings.Our clinic is situated in a vibrant community that values outdoor activities, culinary experiences, and,...


  • Scottsdale, Arizona, United States Absolutely Able Home Care Full time

    Position Overview: Front Office ReceptionistAbsolutely Able Home Care is seeking a dedicated front office receptionist to enhance our operational efficiency. While prior experience in a healthcare setting is advantageous, it is not a strict requirement. This role provides over 35 hours of work weekly, along with available benefits.Key Responsibilities:Handle...


  • Scottsdale, Arizona, United States Atlas Healthcare Partners, LLC Full time

    At Atlas Healthcare Partners, LLC, we are proud to present an opportunity at our state-of-the-art Ambulatory Surgery Center, which focuses on Orthopedic and Pain management procedures. Our facility is renowned for its collaborative culture and supportive environment. This role offers a Monday through Friday schedule, ensuring a work-life balance with no...


  • Scottsdale, Arizona, United States Accor North America Full time

    Join Our Team as a Luxury Nail Care Specialist At Accor North America, we pride ourselves on providing exceptional experiences for our guests. As a Nail Care Specialist, you will play a vital role in delivering high-quality services that promote relaxation and rejuvenation. Your Role: Expertise in Nail Treatments: Utilize your skills to offer a variety...


  • Scottsdale, United States CQ Partners Full time

    Job DescriptionJob DescriptionAspire Audiology and Hearing Center a privately-owned Audiology practice in Scottsdale, Arizona is seeking a Patient Care Coordinator to join our team. We are a brand new, state of the art Audiology practice that values service and helping our patients hear better above all else. We strive to provide the best hearing healthcare...


  • Scottsdale, Arizona, United States Absolutely Able Home Care Full time

    Position Overview: Front Office ReceptionistAbsolutely Able Home Care is seeking a dedicated front office receptionist to enhance our operations. While prior experience in a healthcare setting is advantageous, it is not a strict requirement. This role provides over 35 hours of work weekly, accompanied by a range of benefits.Key Responsibilities:Handle...