We have other current jobs related to this field that you can find below
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Prior Authorization Specialist
2 weeks ago
Atlanta, United States Southeastern Rheumatology Alliance Full timeJob DescriptionJob DescriptionSoutheastern Rheumatology Alliance is seeking a dedicated and customer-oriented Prior Authorization Specialist to join our healthcare team in Atlanta, GA. The Prior Authorization Specialist is responsible for managing and processing requests for prior authorization from healthcare providers to ensure that medical services,...
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Surgery Prior Authorization Specialist
2 weeks ago
Atlanta, United States PEDIATRIC EAR NOSE & THROAT OF ATLANTA PC Full timeJob DescriptionJob DescriptionJob Title: Surgery Prior Authorization SpecialistLocation: Atlanta/Sandy Springs, GAJob Type: Full-TimeAbout Us:We are a leading Pediatric Ears, Nose, & Throat practice in Atlanta dedicated to providing exceptional care to our patients. We are currently seeking a skilled and detail-oriented individual to join our team as a...
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Biologic Prior Authorization Specialist
2 months ago
Atlanta, United States SENTA Partners Full timeDescriptionPosition Summary: Biologic Prior Authorization Specialist is an individual who manages a patient's journey from prescription to drug acquisition. This role navigates the complexities of patient access on behalf of those prescribed biologics. Responsible for communicating with office staff, providers, insurance providers, completing enrollment...
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Prior Authorization Nurse
1 month ago
Atlanta, Georgia, United States A-Line Staffing Solutions Full timePRIOR AUTHORIZATION NURSE JOB Summary:Provide processing and communication of specialty medication prior authorization (PA) requests reviewed by the Specialty Medical Prior Authorization department.Work with physician office staff and customer service, admissions and pharmacy operations departments to communicate prior authorization status.Oversee fax...
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Prior Authorization Specialist
4 weeks ago
Atlanta, United States Select Specialty Hospital Full timeOverview Critical Illness Recovery Hospital Payor Relations Specialist (Precert Nurse) At Select Specialty/Regency Hospitals, a division of Select Medical, we care for chronically and critically ill or post-ICU patients who require extended hospital care. Select Medical employs over 48,000 people across the country and provides quality care to...
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Prior Authorization Representative
2 months ago
Atlanta, United States Warbird Consulting Partners Full timeJob DescriptionJob DescriptionWarbird Healthcare Advisors seeks experienced Prior Authorization Representatives (PARs) for a remote opportunity with a Durable Medical Equipment client. The Prior Authorization Representatives support the Centralized Business Office by performing all tasks required to obtain referrals/authorizations and verifying patients'...
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Oncology Drug Authorization Specialist
1 day ago
Atlanta, Georgia, United States Medical Practice Full timeJob SummaryWe are seeking a highly skilled and experienced Prior Authorization Specialist to join our Medical Practice team. As a Prior Authorization Specialist, you will play a critical role in ensuring that our patients receive the necessary coverage for their chemotherapy treatments.ResponsibilitiesObtain insurance authorization and pre-certification for...
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Oncology Drug Authorization Specialist
6 hours ago
Atlanta, Georgia, United States Medical Practice Full timeJob SummaryWe are seeking a highly skilled and experienced Prior Authorization Specialist to join our Medical Practice team. As a Prior Authorization Specialist, you will play a critical role in ensuring that our patients receive the necessary coverage for their chemotherapy treatments.ResponsibilitiesObtain insurance authorization and pre-certification for...
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Prior Authorization Pharmacy Tech II
3 days ago
Atlanta, United States US Tech Solutions, Inc. Full timeDuration: 06 Months Summary: This position takes in-coming calls from members, providers, etc providing professional phone assistance to all callers through the criteria based prior authorization process. Maintains complete, timely and accurate documentation of all approvals and denials, and transfers all clinical questions and...
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Clinical Services Authorization Specialist
6 days ago
Atlanta, Georgia, United States US Tech Solutions Full timeJob Title: Clinical Services Authorization Specialist Location: Fully remote Duration: 10 months contract Job Overview: The Clinical Services Authorization Specialist will play a vital role in supporting various operational tasks, including but not limited to: making outbound calls, reviewing and processing authorization requests received through...
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Customer Service Representative
4 weeks ago
Atlanta, United States ASK Consulting Full timeJob DescriptionJob Description"All candidates must be directly contracted by ASK Consulting on their payroll and cannot be subcontracted. We are unable to provide sponsorship at this moment".Job Title: Customer Service Representative (Prior Authorization Expertise)Location: Atlanta, GA 30301Duration: 12 months Pay rate: $ 17.50 on W2. Prefer candidates from...
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Insurance Authorization Specialist
4 weeks ago
Atlanta, United States ORTHOATLANTA, LLC Full timeJob DescriptionJob DescriptionDescription:The Insurance Verification Specialist contacts insurance companies to determine pre-certification, prior authorization and/or medical necessity requirements for outpatient Radiology Procedures. Submits all appropriate clinical information to acquire authorization. Works closely with physicians and physician office...
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Prior Auth
12 hours ago
Atlanta, United States Prestige Staffing Full timeOnsite Prior Authorization Specialist Job Overview Position requires utilization of clinical knowledge and excellent customer service skills to schedule appropriate procedures/surgeries per provider???s orders in the hospital, ambulatory surgery center or in office places of service. Location: Smyrna, GA Hours: Normal Business Hours 3 month contract to...
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Atlanta, United States Medical Practice Full timeBusy, Complex Oncology Practice Seeking Prior Authorization Specialist! Pharmacy Technician Assistant/Certified Medical Assistant (if has Prior Hematology/Oncology Experience) Encouraged to Apply! _ Opportunity for a hybrid schedule after demonstrated proficiency and performance! _Seeking a committed individual with prior Oncology experience to work with our...
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Insurance Authorization Coordinator
5 days ago
Atlanta, Georgia, United States Southeastern Rheumatology Alliance Full timePosition OverviewSoutheastern Rheumatology Alliance is in search of a committed and service-oriented Prior Authorization Specialist to enhance our healthcare operations. This role is pivotal in overseeing and facilitating requests for prior authorization from medical professionals, ensuring that necessary treatments, services, and medications receive...
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Insurance Authorization Coordinator
2 hours ago
Atlanta, Georgia, United States Southeastern Rheumatology Alliance Full timePosition OverviewThe Southeastern Rheumatology Alliance is in search of a committed and service-oriented Prior Authorization Specialist to enhance our healthcare operations. This role is pivotal in managing and facilitating requests for prior authorization from medical professionals, ensuring that treatments, services, and medications are adequately covered...
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Insurance Authorization Coordinator
5 days ago
Atlanta, Georgia, United States Southeastern Rheumatology Alliance Full timePosition OverviewSoutheastern Rheumatology Alliance is in search of a committed and detail-oriented Prior Authorization Specialist to enhance our healthcare operations. This role is pivotal in managing and processing prior authorization requests from healthcare professionals, ensuring that medical services, treatments, and medications are adequately covered...
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Imaging Authorization Specialist
6 days ago
Atlanta, Georgia, United States US Radiology Specialists Full timeU.S. Radiology Specialists is in search of an Imaging Authorization Specialist to join our dynamic team. In this role, you will be responsible for managing the approval process for imaging services. Your primary tasks will include liaising with legal representatives to secure necessary authorizations. Key responsibilities encompass:Initiating contact with...
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Authorization Specialist l
2 weeks ago
Atlanta, United States Pyramid Consulting, Inc Full timeImmediate need for a talented Authorization Specialist l. This is a 04+ months contract opportunity with long-term potential and is located in North Carolina(Remote). Please review the job description below and contact me ASAP if you are interested. Job ID: 24-39333 Pay Range: $19/hour. Employee benefits include, but are not limited to, health...
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Authorization Specialist l
2 weeks ago
Atlanta, United States Pyramid Consulting Full timeImmediate need for a talented Authorization Specialist l. This is a 04+ months contract opportunity with long-term potential and is located in North Carolina(Remote). Please review the job description below and contact me ASAP if you are interested. Job ID: 24-39333 Pay Range: $19/hour. Employee benefits include, but are not limited to, health...
Prior Authorization Specialist
2 months ago
Job Title: Prior Authorization Specialist
Location: Fully remote
Duration: 12 months contract
Job Description:
The Rep I, Clinical Services takes in-bound calls from providers, pharmacies, members, etc providing professional and courteous phone assistance to all callers through the criteria based prior authorization process. Maintains complete, timely and accurate documentation of reviews. Transfers all clinical questions, escalations and judgement calls to the pharmacist team.
The Rep I, Clinical Services will also assist with other duties as needed to include but not limited to outbound calls, reviewing and processing Prior Auth’s received via fax and ePA, monitoring and responding to inquiries via department mailboxes and other duties as assigned by the leadership team.
Work closely with providers to process prior authorization (PA) and drug benefit exception requests for multiple clients or lines of business and in accordance with Medicare Part D CMS Regulations. Must apply information provided through multiple channels to the plan criteria defined through work instruction. Research and conduct outreach via phone to requesting providers to obtain additional information to process coverage requests and complete all necessary actions to close cases. Responsible for research and correction of any issues found in the overall process. Phone assistance is required to initiate and/or resolve coverage requests. Escalate issues to Coverage Determinations and Appeals Learning Advocates and management team as needed. Must maintain compliance at all times with CMS and department standards. Position requires schedule flexibility and additional cross training to learn all lines of business. Flexibility for movement to different parts of the business to support volume where needed.
Responsibilities:
· Utilizing multiple software systems to complete Medicare appeals case reviews
· Meeting or exceeding government mandated timelines
· Complying with turnaround time, productivity and quality standards
· Conveying resolution to beneficiary or provider via direct communication and professional correspondence
· Acquiring and maintaining basic knowledge of relevant and changing Med D guidance
· Effectively manage work volume by handling inbound calls/fax/ePA requests utilizing appropriate courteous and professional behaviour based upon established standards.
· Comply with departmental, company, state, and federal requirements when processing all information to ensure accuracy of information being provided to internal and external customers.
· Communication with other internal groups regarding determination status and results (seniors, pharmacists, appeals, etc).
· Identify and elevate clinical inquiries to the pharmacist team as appropriate.
Experience:
· 0-3 years in a customer service or call centre environment managing 75 calls/day.
· Six months of PBM/pharmaceutical related work strongly desired
· At least two years of general business experience that includes problem resolution, business writing, quality improvement and customer service
Skills:
· Prior Authorization
· Medicare and Medicaid
· Call handling experience.
Education:
· High School diploma or GED
