Lead and oversee Prior Authorization Operations across all lines of business.
Manage Prior Authorization processes ensuring optimal efficiency and compliance.
Drive cross-functional collaboration to align with organizational goals.
Judi Health is an enterprise health technology company providing a comprehensive suite of solutions for employers and health plans. They are rebuilding trust in healthcare in the U.S. and deploying the infrastructure we need for the care we deserve.
Provides policy expertise related to systems or products.
Communicates Medicaid program insight to UX researchers and designers.
Analyzes laws and policy documents and explains their impact.
A1M Solutions is a woman-owned small business focused on providing value to customers, employees, partners, and the community, while remaining aligned to its guiding principles. A1M’s mission is to preserve and improve government healthcare programs for underserved people in the United States, focusing on projects with nation-wide impact at the intersection of policy, data, and user experience design.
Directly communicate with insurance companies to facilitate the approval of medications.
Navigate pharmacy operating systems to input data and prepare action plans for follow-up.
Communicate directly with patients over the phone to assist them in medication compliance.
Shields Health Solutions provides integrated pharmacy solutions. They partner with hospitals and health systems to improve patient outcomes and create financial value.
Complete monthly utilization management and appeals performance and process audits.
Present audit results to leadership to address issues.
Assist management in identifying, evaluating, and mitigating risks.
Judi Health provides a comprehensive suite of solutions for employers and health plans. They offer full-service health benefit management solutions and consolidate all claim administration-related workflows in one scalable, secure platform.
Manage prior authorizations and related administrative paperwork.
Input patient information, medical records (CPT, ICD-10, HCPCS), and billing data into EMR/EHR systems.
Assist with processing insurance claims, verifying patient insurance information, and handling billing inquiries, concerns, and documentation.
Wing is redefining the future of work for companies worldwide. They aim to be a one-stop shop for companies looking to build world-class teams and place their operations on autopilot.
Source, interpret, and scope new payment integrity policies.
Prioritize policy updates based on savings potential and client impact.
Quantify and communicate policy value through data-driven analysis.
Rialtic, Inc. focuses on healthcare payment expertise, client strategy, and product innovation. They seem to have a culture that values collaboration and impact, although the job post doesn't specify size/employees.
Evaluate and review all appeals requests to render coverage determinations based on clinical criteria and medical necessity.
Perform scientific literature evaluation using primary, secondary, and tertiary drug resources to support decision-making and recommendations to providers.
Make clinical prior authorization determinations in accordance with medical necessity and covered benefit guidelines within established turnaround times.
Judi Health offers full-service health benefit management solutions to employers, TPAs, and health plans, and Judi® the industry’s leading proprietary Enterprise Health Platform (EHP). Together with our clients, they’re rebuilding trust in healthcare in the U.S. and deploying the infrastructure we need for the care we deserve.
Reviewing patient care notes for clinical data needed for approvals and care plan recommendations.
Monitoring patient adherence across all sites and disease categories.
Recommending alternative therapeutic drug regimens and disease specific treatments according to guidelines.
Shields Health Solutions provides integrated support to patients and physicians. They improve the quality of patient care by personalizing relationships with patients and prescribers to improve medication adherence and promote evidence-based care.
Communicate with patients over the phone about the benefits of the Shields Partner Pharmacy program.
Access patient EMRs to review charts and identify medication needs.
Identify necessary supplies for medications and ensure proper handling.
Shields Health Solutions partners with hospitals and health systems to create specialty pharmacy programs. They focus on improving medication access, adherence, and clinical outcomes for patients with chronic and complex conditions. The company is an equal opportunity employer that values diversity and inclusion.
Showcase customer service and data entry skills as part of the healthcare team.
Involved in claims adjudication and/or provider credentialing.
Support customers by phone, email and chat.
Sutherland helps customers globally achieve greater agility and transform automated customer experiences. As a digital transformation company they have been in business for over 35 years and are Great Place to Work certified with nearly 40,000 employees.