Review, process, and troubleshoot incoming Prior Authorization requests for various medications.
Accurately process requests according to regulatory and client-specific guidelines while meeting departmental performance metrics.
Work with clinical teams and handle requests via phone, fax, and web submission.
Navitus is a pharmacy benefit manager (PBM) alternative focused on reducing drug costs to make medications more affordable. The company offers a diverse and creative work environment with numerous employee benefits and growth opportunities.
Verify insurance, obtain benefits, calculate estimates, and secure prior authorizations for outpatient services.
Act as liaison between payers and clinic staff; follow up on denied or delayed authorizations.
Maintain detailed documentation and resolve issues with physicians, nurses, and financial advocates.
University of Utah Health is a patient-focused organization enhancing health through care, research, and education. It operates five hospitals and eleven clinics with a culture of collaboration, excellence, leadership, and respect.
Assist members, providers, and internal teams in navigating prescription coverage and prior authorization requests.
Verify eligibility, drug coverage, and perform claims adjudication based on plan benefit design.
Triage and prioritize multiple requests, coordinate outreach, and make determinations under protocol.
SmithRx is a health-tech company disrupting the pharmacy benefit management industry with a next-generation drug acquisition platform. With hundreds of thousands of members, they have a mission-driven and collaborative culture guided by values of integrity, courage, and together.
Review prior authorization cases to ensure clinical and operational standards are met.
Audit AI outputs, third-party reviews, and internal decisions for accuracy and compliance.
Collaborate cross-functionally to refine workflows and improve patient access to treatment.
Generator Health operates a platform that streamlines prior authorization processes for patients and providers. They handle tens of thousands of patients weekly and emphasize collaboration and accuracy in a high-autonomy remote environment.
Collects and verifies patient demographic and insurance information prior to scheduled appointments.
Ensures smooth registration process and accurate financial clearance to support timely access to services.
Maintains compliance with regulatory and confidentiality standards while performing other assigned duties.
Kettering Health is a healthcare system serving communities in Ohio, dedicated to patient-centered care. With multiple facilities and a large workforce, it emphasizes a culture of safety, compliance, and operational excellence.
Handle inbound calls, chats, emails, and faxes from healthcare providers, resolving questions on authorizations, claims, and provider services.
Document each interaction, research issues, and ensure accurate, timely follow-up with providers.
Guide providers through processes like checking authorization status, submitting claims, and navigating the provider portal.
Curana Health is a national leader in value-based care, offering senior living and skilled nursing facilities solutions such as on-site primary care, ACOs, and Medicare Advantage plans. Founded in 2021, it serves 200,000+ seniors in 1,500+ communities across 32 states with 1,000+ clinicians.
Provides high-quality customer service to patients and providers, managing high-volume phone calls, scheduling, and managed care authorizations.
Processes referrals, verifies insurance, and prepares materials for clinic visits and ancillary procedures.
Triages and documents patient calls in EPIC, communicates with providers, and handles administrative tasks to support the Pediatric Neurology practice.
OHSU is Oregon's only public academic health center, providing patient care, leading research, and training health care professionals. As Portland's largest employer, it offers opportunities to learn and advance across a system of hospitals and clinics.
Assist patients with enrolling in our Prescription Payment Plan and verifying eligibility.
Coordinate with pharmacies to apply benefits and reduce out-of-pocket costs.
Guide patients through renewals and updates to ensure continued access.
We are a team dedicated to improving access to affordable prescription medications for patients. We partner with insurance companies, healthcare providers, and pharmacies to reduce the financial burden of medications, ensuring patients can access treatments without excessive costs.