Work with ABA/behavioral health providers to collect patient information and communicate authorization decisions
Verify patient eligibility and benefits with insurers and complete prior authorizations via portals or calls
Manage multiple authorizations and collaborate with product team to automate parts of the process
Silna Health is obsessed with optimizing the broken healthcare system by automating prior authorizations and eligibility checks. Backed by Accel and Bain Capital Ventures, they are a fast-growing company working across behavioral health, physical health, ambulatory care, and post-acute care.
Applies approved utilization criteria to monitor appropriateness of admissions and continued stay reviews.
Communicates with third-party payers for initial and concurrent clinical review to ensure medical necessity.
Tracks length of stay and resource utilization to identify at-risk patients and supports appeals on denied cases.
University of Utah Health is a patient-focused healthcare organization dedicated to enhancing health and well-being through patient care, research, and education. It is a nationally ranked Level 1 Trauma Center with five hospitals and eleven clinics, fostering a culture of collaboration, excellence, and respect.
Manage prior authorization workflows with vendors, providers, patients, and payors.
Develop processes and training materials for offshore teams to resolve authorization issues.
Own Prior Authorization outcomes and KPIs for your region or payors.
Alpaca Health enables clinicians to become entrepreneurs, starting in autism care. We've raised over $14M in funding and are growing 30% - 50% month over month, serving thousands of patients.
Own first-level reviews of pre-certification requests for medical appropriateness and necessity.
Drive post-service reviews and manage the appeals process for non-certified services.
Coordinate smooth discharges and redirect care in-network to keep patients on track.
Personify Health created the first personalized health platform, bringing health plan administration, wellbeing solutions, and care navigation together in one place. Their team serves employers, health plans, and health systems with a mission to empower people to lead healthier lives.
Perform clinical reviews for medical necessity, level of care, and authorization-related denials.
Review inpatient and outpatient medical records to support appeal submissions and apply payer-specific guidelines.
Document review findings accurately and meet assigned turnaround times while maintaining quality standards.
CorroHealth helps clients exceed their financial health goals by providing scalable solutions and clinical expertise across the reimbursement cycle. The company fosters a supportive culture that invests in professional development and personal growth.
Prepare prior authorization requests by validating prescriber and member information and ensuring appropriate clinical guidelines.
Make outbound calls to providers to obtain additional clinical information for pharmacist review.
Review and analyze pharmacy claims data for proactive outreach and intervention.
Judi Health is an enterprise health technology company offering pharmacy benefit management and health benefit solutions for employers and health plans. They are a startup focused on rebuilding trust in healthcare in the U.S.
Manage insurance authorization workflows from initial request through final approval.
Verify insurance eligibility, benefits, and authorization requirements.
Collaborate with clinical and billing teams to ensure timely processing.
The company is a healthcare operations organization focused on managing insurance authorization processes to support patient care. They offer a collaborative remote work environment with cross-functional teams.
Manage referral management portals and process incoming referrals.
Perform insurance benefit verifications and coordinate admissions.
Respond to inquiries about facilities within policy timeframes.
Acadia Healthcare is a national leader in treating individuals with acute co-occurring mood, addiction, and trauma. They emphasize admissions and intake functions to help every possible person in need.
Perform prospective, concurrent, and retrospective utilization reviews for behavioral health services across multiple care settings.
Assess medical necessity and coordinate care with providers, members, and internal teams to ensure appropriate access and treatment.
Support discharge planning, benefit utilization, and regulatory compliance while improving overall care quality.
This company provides high-quality behavioral health coordination and utilization management services to improve member outcomes. They foster a supportive, collaborative environment focused on professional growth and clinical excellence.
Authorize, direct and monitor care for behavioral health and/or substance abuse problems according to clinical information.
Conduct peer reviews with psychologists, behavioral health therapists and/or Board Certified Behavior Analysts.
Interact with network practitioners to provide education on best practice models and utilization management processes.
Centene is a diversified national health insurance organization providing access to high-quality healthcare, innovative programs, and health solutions for families and individuals. They serve 28 million members and offer a collaborative, supportive team committed to clinical excellence.
Act as a patient and family advocate to obtain necessary information and fulfill payer authorization requirements.
Collaborate with providers and staff to ensure successful referral and authorization processes.
Track, follow up, and resolve authorization issues to minimize financial risks.
Lucile Packard Children's Hospital Stanford provides world-renowned pediatric care combining advanced technologies with family-centered care. It is a major children's hospital dedicated to caregiver education and state-of-the-art facilities.
Set daily direction for your UM team, establishing priorities and reinforcing expectations.
Coach reviewers on criteria application, guiding consistent use of medical-necessity criteria.
Monitor workflow health daily, tracking intake volume and turnaround risk.
Personify Health created the first and only personalized health platform, bringing health plan administration, holistic wellbeing solutions, and comprehensive care navigation together. The team is on a mission to empower people to lead healthier lives.
Provide telephonic case management to proactively drive return to work.
Perform utilization review and coordinate care with providers and adjusters.
Evaluate treatment plans and partner with adjusters to achieve optimal outcomes.
AmTrust Financial Services is a fast-growing commercial insurance company providing comprehensive telephonic case management. They foster a diverse and inclusive culture with a focus on attracting and retaining the best talent.
Perform clinical reviews and conduct peer-to-peer discussions.
Participate in inter-rater reliability activities and clinical rounds.
Serve as a clinical resource and subject matter expert to clinical and non-clinical staff.
Devoted Health is a healthcare company that aims to improve the health and well-being of older Americans through a data and AI-driven care platform. The company values diversity, collaboration, and a supportive work environment, and is an equal opportunity employer.
Manage referral management portals and monitor all faxed and webform referrals.
Perform insurance benefit verifications and coordinate admissions with facility departments.
Document calls in Salesforce and ensure compliance with confidentiality policies.
Acadia Healthcare is a world-class organization that sets the standard for excellence in the treatment of mental health and addiction concerns. They are one of the nation's leaders in treating individuals with acute co-occurring mood, addiction, and trauma, with a strong emphasis on admissions and intake functions.
Ensure admissions are coordinated from start to finish, maintaining knowledge of census and bed board for efficient patient flow.
Coordinate with patients, families, referral sources, UR, and finance to ensure expedited access to care.
Collect and present medical and psycho-social documentation to clinical staff to support timely admissions.
ERC Pathlight is a leading national provider of treatment for eating disorders, mood, anxiety, and trauma-related conditions. Founded in 2008, the organization supports over 6,000 patients annually with multiple locations and virtual programming.
Review and process prior authorizations for biologics, oncology, and specialty therapies with timely and accurate completion.
Manage clinical documentation, submit and track authorization requests, and resolve issues with insurance providers.
Communicate effectively with patients, clinical staff, and insurance representatives to ensure compliance and workflow efficiency.
IVX Health is a national provider of infusion and injection therapy for individuals managing chronic conditions like Rheumatoid Arthritis, Crohn's Disease, and Multiple Sclerosis. They are a rapidly growing company focused on patient comfort and employee empowerment, with core values of kindness, integrity, and continuous improvement.
Create and maintain credentialing and renewal information for Workit providers, ensuring accuracy in payor directories and online systems.
Work closely with the Credentialing Manager and billing staff to resolve denials or authorization issues related to provider credentialing.
Complete revalidation requests issued by payers and maintain up-to-date data for each provider in the credentialing database.
Workit Health is an industry-leading provider of on-demand, evidence-based telemedicine care for addiction, offering FDA-approved medication and online recovery groups. The company has a vibrant, democratized culture with multiple ERG groups and opportunities for internal mobility, committed to closing health disparity gaps.
Investigate and resolve Coordination of Benefits denials by working with insurance carriers and members.
Conduct outreach to members to collect, verify, and update insurance information, providing clear guidance on benefits.
Maintain accurate member account records by documenting verified insurance details and coverage changes.
The company is a mission-driven healthcare organization focused on improving access to care. The size and culture are not specified, but the environment emphasizes teamwork, continuous improvement, and meaningful impact.
Review and verify insurance coverage, obtain authorizations, and create patient liability estimates while working closely with internal and external stakeholders.
Serve as a liaison between patients, providers, and insurance companies to ensure accurate financial services and resolve managed care issues.
Provide backup support and cross-coverage for the Centralized Managed Care & Price Estimates Department, including handling trauma admissions and third-party liability.
OHSU is Oregon's only public academic health center, providing patient care, leading groundbreaking research, and training the next generation of healthcare professionals. As Portland's largest employer, it offers a diverse and inclusive culture with opportunities for growth and advancement.