Prior Authorization
1 week ago
Genesis10 is seeking a Prior Authorization & Appeals Quality Analyst for a contract with our client. 100% Remote. Job Description: Senior Analyst(s) will be responsible for end-to-end business process activities - creating, controlling and improving the performance guarantee processes related to Prior Authorization and Appeals. They will lead process design and project implementation teams to assure program compliance and quality control for adherence to audit requirements based on governing bodies for the 19 states serviced by Health Care Company Community and State. Key Responsibilities: Responsible for diagnosing process improvement opportunities and developing solutions using principles of process excellence and related tools. Quality reporting, analysis, audits and for developing plans and programs to support continuous quality improvement using applicable tools. May assist in the creation, implementation, and evaluation of Total Quality Management (TQM) programs surrounding PA and Appeal related performance guarantees. May direct design, facilitation, training and evaluation of TQM incentive programs and may oversee quality improvement projects and teams in functional area. The Prior Authorization Governance and Auditing Group provides audit and regulatory support related to Prior Authorization and Appeals for all clients of OptumRx. The analyst(s) will serve as the regulatory subject matter expert during oversight and delegation audits performed by various clients. Analyst(s) will be responsible to analyze and report OOC data, perform clinical review on all DOI inquiries to ensure the PA and appeal process are aligned with regulatory guidance. Analyst(s) will lead data validation efforts for PA and Appeals including quality control for adherence to accreditation, state and federal program requirements. Clinical validation includes review of prior authorization cases for clinical decision-making based on individual plan formulary and requirement and patient demographics. The analyst(s) will ensure compliance to various regulations based on lines of business and plan design. In addition to audit support, the analyst(s) will be involved with trending to identify process improvements to ensure compliance with applicable state and federal laws, business contract requirements, prevent untimely cases and maintain client relations. Analyzes and investigates root cause of non-compliant cases. Compensation: Hourly W2 pay rate $ We have access to additional contract, contract-to-hire, and direct hire positions with various rate ranges. If you have the described qualifications and are interested in this exciting opportunity, apply today Ranked a Top Staffing Firm in the U.S. by Staffing Industry Analysts for six consecutive years, Genesis10 puts thousands of consultants and employees to work across the United States every year in contract, contract-for-hire, and permanent placement roles. With more than 300 active clients, Genesis10 provides access to many of the Fortune 100 firms and a variety of mid-market organizations across the full spectrum of industry verticals. For contract roles, Genesis10 offers the benefits listed below. If this is a perm-placement opportunity, our recruiter can talk you through the unique benefits offered for that particular client. Benefits of Working with Genesis10: Access to hundreds of clients, most who have been working with Genesis10 for 5-20+ years. The opportunity to have a career-home in Genesis10; many of our consultants have been working exclusively with Genesis10 for years. Access to an experienced, caring recruiting team (more than 7 years of experience, on average.) Behavioral Health Platform Medical, Dental, Vision Health Savings Account Voluntary Hospital Indemnity (Critical Illness & Accident) Voluntary Term Life Insurance 401K Sick Pay (for applicable states/municipalities) Commuter Benefits (Dallas, NYC, SF) Remote opportunities available For multiple years running, Genesis10 has been recognized as a Top Staffing Firm in the U.S., as a Best Company for Work-Life Balance, as a Best Company for Career Growth, for Diversity, and for Leadership, amongst others. To learn more and to view all our available career opportunities, please visit us at our website. Genesis10 is an Equal Opportunity Employer. Candidates will receive consideration without regard to their race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.
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Prior Authorization Specialist
2 weeks ago
Minneapolis, Minnesota, United States TAJ Technologies Inc Full timePOSITION SUMMARYThe Prior Authorization Specialist plays a crucial role in ensuring that patients receive timely access to necessary therapies by verifying and obtaining prior authorizations as needed. This position involves direct collaboration with healthcare providers and insurance companies to facilitate the authorization process.KEY...
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Prior Authorization Specialist
2 months ago
Minneapolis, Minnesota, United States Inspire Medical Systems, Inc. Full timePRIOR AUTHORIZATION SPECIALIST ABOUT INSPIRE MEDICAL SYSTEMS Inspire is the first of its kind medical device designed to make a difference in the lives of those living with Obstructive Sleep Apnea (OSA). We are revolutionizing the sleep industry with our FDA-approved medical device, designed to reduce OSA severity for those who cannot tolerate or get...
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Prior Authorization/Pre-Certification Coordinator
2 months ago
Minneapolis, United States Minnesota Urology P.A. Full timeJob DescriptionJob DescriptionMN Urology is currently seeking a full time Prior Authorization CoordinatorPosition is located in our Edina, MN clinicMonday-FridayRegular Daytime Hours, No Evenings, No Weekends, No Holidays!The Prior Authorization/Pre-Certification Coordinator is responsible for performing prior authorizations, pre-certifications for...
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Prior Authorization
2 weeks ago
Minneapolis, United States Genesis10 Full timeGenesis10 is seeking a Prior Authorization & Appeals Quality Analyst for a contract with our client. 100% Remote. Job Description: Senior Analyst(s) will be responsible for end-to-end business process activities - creating, controlling and improving the performance guarantee processes related to Prior Authorization and Appeals. They will lead process design...
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Prior Authorization
1 week ago
Minneapolis, United States Genesis10 Full timeGenesis10 is seeking a Prior Authorization & Appeals Quality Analyst for a contract with our client. 100% Remote.Job Description: Senior Analyst(s) will be responsible for end-to-end business process activities - creating, controlling and improving the performance guarantee processes related to Prior Authorization and Appeals. They will lead process design...
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Prior Authorization
2 weeks ago
Minneapolis, United States Genesis10 Full timeGenesis10 is seeking a Prior Authorization & Appeals Quality Improvement Analyst for a contract with our client in Minneapolis, MN. 100% Remote. Job Description: Senior Analyst(s) will be responsible for end-to-end business process activities - creating, controlling and improving the performance guarantee processes related to Prior Authorization and...
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Prior Authorization
3 weeks ago
Minneapolis, United States Genesis10 Full timeGenesis10 is seeking a Prior Authorization & Appeals Quality Improvement Analyst for a contract with our client in Minneapolis, MN. 100% Remote.Job Description: Senior Analyst(s) will be responsible for end-to-end business process activities - creating, controlling and improving the performance guarantee processes related to Prior Authorization and Appeals....
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Minneapolis, United States Optum Full timeOpportunities at Optum, in strategic partnership with Allina Health. As an Optum employee, you will provide support to the Allina Health account. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data, and resources they need to feel their best. Here, you will find a culture guided by...
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Pharmacy Technician
3 months ago
Minneapolis, United States Department Of Veterans Affairs Full timeSummary **A Recruitment Incentive has been authorized for Highly Qualified Applicants** The Outpatient Rotational Pharmacy Technician is a highly trained technician responsible for a variety of functions in the outpatient pharmacy. These include dispensing/distribution of...
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Pharmacy Technician
3 months ago
Minneapolis, United States Department Of Veterans Affairs Full timeSummary **A Recruitment Incentive has been authorized for Highly Qualified Applicants** The Outpatient Rotational Technician is a highly trained technician responsible for a variety of functions in the outpatient pharmacy. These include dispensing/distribution of...
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Customer Service Rep
3 months ago
Minneapolis, United States TAJ Technologies Inc Full timeJOB DESCRIPTION •The Prior Authorization Representative is responsible for verifying prior authorization requirements and obtaining authorization when required. Works directly with physician offices and payers to facilitate patient access to various therapies. Representative will ensure patient insurance coverage and benefits, identify requirements for...
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Insurance Denial Specialist
4 weeks ago
Minneapolis, Minnesota, United States University of Minnesota Physicians Full timeWhy M Physicians?Regardless of role, we recognize that every member of our team is vital TheInsurance Denials Specialistverifies health insurance, obtaining benefits and meeting payer requirements to secure prior authorization(s). Acts as a liaison between patients, their health insurance, care providers and financial counselors, to assist in understanding...
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Senior Quality Assurance Analyst
2 days ago
Minneapolis, Minnesota, United States Contech Systems Full timeJob SummaryWe are seeking a highly skilled and experienced Senior Quality Assurance Analyst to join our team at Contech Systems. In this role, you will be responsible for end-to-end business process activities, including creating, controlling, and improving performance guarantee processes related to Prior Authorization and Appeals.Key ResponsibilitiesProcess...
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Insurance Denial Specialist
3 weeks ago
Minneapolis, United States University of Minnesota Physicians Full timeWhy M Physicians? Regardless of role, we recognize that every member of our team is vital! TheInsurance Denials Specialistverifies health insurance, obtaining benefits and meeting payer requirements to secure prior authorization(s). Acts as a liaison between patients, their health insurance, care providers and financial counselors, to assist in understanding...
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IT-Qlty Analyst/27/TEC250
4 days ago
Minneapolis, United States Contech Systems Full timeLocation: RemoteCompany: UnitedHealth GroupJob Overview:We are seeking a highly skilled and experienced Senior Analyst to join our Prior Authorization and Appeals Governance team. In this role, you will be responsible for end-to-end business process activities, including creating, controlling, and improving performance guarantee processes related to Prior...
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Pharmacy Care Technician
2 weeks ago
Minneapolis, United States RTA US Full timeJob DescriptionJob DescriptionWork Mode: RemoteLocation: Phoenix AZ / Las Vegas NV / Henderson NV / Reno NV / Tucson AZ / Mesa AZ / Sedona AZ / Santa Fe New Mexico / Albuquerque New Mexico / Salt Lake City UT / Provo UT / Billings MT / Bozeman MT / Missoula MT / Boise ID / Twin Falls ID / Idaho Falls ID / Portland OR / Oregon City OR / Eugene OR / Salem OR /...
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Pharmacy Care Technician
2 months ago
Minneapolis, United States RTA US Full timeJob DescriptionJob DescriptionWork Mode: RemoteLocation: Phoenix AZ / Las Vegas NV / Henderson NV / Reno NV / Tucson AZ / Mesa AZ / Sedona AZ / Santa Fe New Mexico / Albuquerque New Mexico / Salt Lake City UT / Provo UT / Billings MT / Bozeman MT / Missoula MT / Boise ID / Twin Falls ID / Idaho Falls ID / Portland OR / Oregon City OR / Eugene OR / Salem OR /...
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Quality Analyst
3 weeks ago
Minneapolis, United States ZHH Staffing Full time3 Month ContractDescription:Senior Analyst(s) will be responsible for end-to-end business process activities - creating, controlling and improving the performance guarantee processes related to Prior Authorization and Appeals.Will lead process design and project implementation teams to assure program compliance and quality control for adherence to audit...
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Healthcare Customer Service Specialist
2 weeks ago
Minneapolis, Minnesota, United States Twin Cities Orthopedics Full timeOverviewWe are seeking a dedicated individual to fill the role of Patient Services Representative. This position involves essential responsibilities related to patient registration, check-in procedures, and providing clinical support. The focus will be on managing the prior authorization process to ensure patients receive accurate information regarding their...
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Healthcare audit analyst
2 weeks ago
Minneapolis, United States Randstad Full timejob summary: Senior Analyst(s) will be responsible for end-to-end business process activities - creating, controlling and improving the performance guarantee processes related to Prior Authorization and Appeals. Will lead process design and project implementation teams to assure program compliance and quality control for adherence to audit requirements...