Prior Authorization Specialist
3 weeks ago
Managing patient’s insurance benefits and utilizing established patient assistance programs. Develop client-based relationships with clinical staff and patients, presenting pharmacy service options through customized financial analysis, and facilitating information gathering for program enrollment (patient assistance and indigent programs).
Responsibilities- Liaison between the medical staff, outpatient pharmacies, insurance providers, and patients to improve communication and continuity of care.
- Review patient information and insurance status to identify socioeconomic barriers, opportunities for intervention, and eligibility for prescription assistance.
- Conduct prior authorization services.
- Understand payer reimbursement and patterns for pharmacy and medical claims with third parties.
- Serve as the primary ambulatory pharmacy resource to facilitate access to prescription and medical benefit medications, including but not limited to formulary/coverage issues, copay issues, patient assistance program eligibility, and other indigent programs.
- Coordinate services with appropriate departments and internal patient care team members regarding patients who have limited financial resources for paying for medications and facilitate medication access to support discharge preparations.
- Interact with hospital and clinic employees, including but not limited to pharmacists, clinical staff, fiscal personnel, department managers, access services staff, coding staff, and billing assistants. External contacts include but are not limited to third-party payers, manufacturers, prescription benefit management companies, external pharmacy personnel, and referring providers and their support staff.
- Experience in infusion prior authorization.
- Proficiency with EPIC software, Required.
- Knowledge of medical billing and coding.
- Experience with infusion services.
- Pharmacy technician license.
- Experience in insurance verification.
- Hours: Monday-Friday 8-4:30
Actalent is a global leader in engineering and sciences services and talent solutions. We help visionary companies advance their engineering and science initiatives through access to specialized experts who drive scale, innovation and speed to market. With a network of almost 30,000 consultants and more than 4,500 clients across the U.S., Canada, Asia and Europe, Actalent serves many of the Fortune 500.
Diversity, Equity & InclusionAt Actalent, diversity and inclusion are a bridge towards the equity and success of our people. DE&I are embedded into our culture through:
- Hiring diverse talent
- Maintaining an inclusive environment through persistent self-reflection
- Building a culture of care, engagement, and recognition with clear outcomes
- Ensuring growth opportunities for our people
The company is an equal opportunity employer and will consider all applications without regard to race, sex, age, color, religion, national origin, veteran status, disability, sexual orientation, gender identity, genetic information or any characteristic protected by law.
If you would like to request a reasonable accommodation, such as the modification or adjustment of the job application process or interviewing process due to a disability, please email actalentaccommodation@actalentservices.com for other accommodation options.
-
Infusion Prior Authorization Specialist
4 weeks ago
Saint Louis, United States Actalent Full timeJob DescriptionJob DescriptionSpecialist - Infusion Prior AuthorizationsJob DescriptionPurpose: Managing patient’s insurance benefits and utilizing established patient assistance programs. Develop client-based relationships with clinical staff and patients, presenting pharmacy service options through customized financial analysis, and facilitating...
-
Infusion Prior Authorization Specialist
3 weeks ago
St Louis, United States Actalent Full timeSpecialist - Infusion Prior Authorizations Job Description Purpose: Managing patient's insurance benefits and utilizing established patient assistance programs. Develop client-based relationships with clinical staff and patients, presenting pharmacy service options through customized financial analysis, and facilitating information gathering for program...
-
Infusion Prior Authorization Specialist
3 weeks ago
St Louis, United States Actalent Full timeSpecialist - Infusion Prior Authorizations Job Description Purpose: Managing patient's insurance benefits and utilizing established patient assistance programs. Develop client-based relationships with clinical staff and patients, presenting pharmacy service options through customized financial analysis, and facilitating information gathering for program...
-
Authorization Specialist IV
3 weeks ago
St Louis, United States Centene Corporation Full timeLeads the prior authorization request process to ensure work queue is managed and addressed properly. Provides guidance and expert knowledge to utilization management team on documenting the most complex authorization requests to ensure accurate and Authorization, Specialist, Healthcare, Technology, Insurance
-
Clinical Review Nurse
4 weeks ago
St Louis, United States Spectraforce Technologies Full timeJob Title: Clinical Review Nurse - Prior Authorization Job Location: RemoteJob Duration: 6 Months (Potential to extend)Responsibilities: Review clinical documentation and perform utilization management reviews for prior authorizations When completely trained completing 20-22 authorizations per day at minimum Internal/External Groups with which the Candidate...
-
Authorized Inspector
4 weeks ago
Saint Louis Place, MO, United States Orion Talent Full timePosition Details: Title: ASME Authorized Inspector Location: St. Louis, MO Shift: Monday - Friday - 1st Shift Compensation: $28/hour (pay increases to $35 - $40/hour after you obtain your National Board Commission) Benefits: Company offers a comprehensive benefits package including Medical, Dental, Vision, 401k, Life and Disability Insurance as well as...
-
Payroll Specialist
2 weeks ago
Saint Louis, United States Robert Half Full timeJob DescriptionJob DescriptionWe are seeking a Payroll Specialist for our operations in the construction/contractor industry based in SAINT LOUIS, Missouri. The Payroll Specialist will manage a variety of payroll processes, from processing new staff paperwork to assisting with payroll audits. This role also involves managing payroll-related communication and...
-
Accounts Receivable Specialist
2 months ago
Saint Louis, United States Accounting Career Consultants Full timeJob DescriptionJob DescriptionWhy This Is a Great OpportunityThe Accounts Receivable Specialist role provides an exceptional chance to play a crucial role in managing and optimizing a company’s financial operations. This position offers competitive compensation and a comprehensive benefits package while promoting a culture of excellence, curiosity, and...
-
Child Life Specialist
2 months ago
Saint Louis, United States SSM Health Full timeIt's more than a career, it's a callingMO-SSM Health Cardinal Glennon Children's HospitalWorker Type:RegularJob Highlights:Department: NICUSign On Bonus: $5,000Schedule: Full Time, Day Shift, M-F, 10a-6:30p3-4 weekends per year / 1-2 holidays per yearStarting Pay: $21.89+Shift Differentials: Available for night, weekend, and additional...
-
Child Life Specialist
3 weeks ago
Saint Louis, United States SSM Health Full timeIt's more than a career, it's a callingMO-SSM Health Cardinal Glennon Children's HospitalWorker Type:RegularJob Highlights:· Department: Outpatient Clinics· Sign On Bonus: $2,500· Schedule: Part Time, Days, 7:30a - 4p Mon/Thur/alternating Fri· No Weekends / 1-2 Holidays per...
-
Certified Crisis Peer Specialist
2 months ago
Saint Louis, United States Behavioral Health Response Full timeThe Crisis Certified Peer Specialist (CCPS) provides peer support to individuals with a variety of behavioral health and/or substance use conditions. For this reason, the CCPS will self-identify as a present or former client of mental health or substance use services. With an emphasis on self-directed recovery and using the harm reduction model, the CCPS...
-
Dental Customer Service Specialist
4 weeks ago
Saint Louis, United States La Cross Dental Full timeJob DescriptionJob DescriptionWe are growing again! Summit- Horizon Dental Lab is seeking a Dental Customer Service Specialist to join our team! You will be responsible for helping customers by answering account questions, providing product and service information, as well as entering cases into the scheduling system, and ensuring cases are quality...
-
Accounts Payable Specialist
4 weeks ago
Saint Louis, United States Accounting Career Consultants Full timeJob DescriptionJob DescriptionWhy is This a Great Opportunity?This Accounts Payable Specialist role offers the chance to work within a supportive, growth-focused environment, where your expertise will directly impact the financial accuracy and efficiency of the organization. In this role, you will interact closely with various departments and vendors,...
-
Entry-Level Medical Billing Specialist
5 hours ago
Saint Petersburg, United States Orlick & Kasper Full timeJob Type Full-timeDescriptionAs an Entry-Level Medical Billing Specialist, you will play a crucial role in ensuring accurate and timely reimbursement for healthcare services. You will contribute to the financial success of our organization. Join our team of dedicated professionals who are committed to providing quality healthcare services.Primary...
-
Stormwater Infrastructure Specialist
1 month ago
Lake Saint Louis, Missouri, United States Apex Companies, LLC Full timeStormwater Infrastructure SpecialistWe are seeking a skilled Stormwater Infrastructure Specialist to join our team at Apex Companies, LLC. As a key member of our Utility Division, you will be responsible for repairing and constructing vital stormwater infrastructure, underground utilities, concrete structures, and stormwater basins across the central...
-
Recovery Specialist
3 weeks ago
East Saint Louis, United States Chestnut Health Systems Full timeOverview Share your recovery experience to help others in your role as a Recovery Specialist at Chestnut. Experience the satisfaction of helping to facilitate self-directed recovery. This is a full-time position. It is based in Granite City, IL but may require travel throughout Bond, Clinton, Madison, St. Clair, and Marion Counties. Chestnut offers a new...
-
Nurse LPN/RN Outpatient
4 weeks ago
Saint Louis, United States Compass Health Network Full timeCompensation: $29.00/hr (LPN); $38.00/hr (RN) Due to critical service need of the communities we serve, we are offering up to a $6,000 sign-on bonus.* We are eager to continue to provide quality and compassionate care in our service areas and need you to make this happen! This is a full-time, benefit eligible position working 9-hour shifts on Monday,...
-
Medical Assistant- Peds Multispecialty
6 days ago
Saint Louis, United States Actalent Full timeJob DescriptionJob DescriptionJob Title: Medical Assistant- Peds MultispecialtyJob DescriptionWe are seeking a dedicated Medical Assistant for a pediatric multispecialty clinic. This role primarily involves front office duties, including patient check-in and check-out, patient registration, and rooming pediatric patients. The candidate must be comfortable...
-
Patient Financial Counselor
7 days ago
Saint Charles, United States Illinois Cancer Specialists Full timeOverview: Patient Financial Counselor - Full-Time - Elgin, IL Under general supervision, is responsible for insurance verification and eligibility, assessment of patient financial requirements, counseling patients on insurance benefits and co-payments. Obtains pre-authorization of services. Obtains and maintains accurate patient demographics. Supports and...
-
Back Office Specialist
1 day ago
Lake Saint Louis, United States Vision Integrated Partners (Midwest) Full timeDescription:At Hill Vision Services, we are in the eye care business; better yet, we are in the caring for all, business! We care for our team members, just as much as we care for our patients and strive in providing a warm, positive, and energetic atmosphere we can all feel comfortable with. Our team members are the backbone of our practice and are the ones...