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.
Communicate directly with insurance companies to facilitate medication approvals and prior authorizations.
Navigate pharmacy systems to enter data, adjudicate claims, and document patient interactions across multiple databases.
Provide compassionate phone support to patients, helping them manage refills, medication adherence, and pharmacy-related questions.
Shields Health Solutions partners with health systems to provide specialty pharmacy services, helping patients access complex medications. As a growing organization, they emphasize a collaborative culture and patient-centered care, employing pharmacy professionals dedicated to improving medication adherence and health outcomes.
Provide expertise in prior authorization and implement the Inspire Prior Authorization Program.
Support patient intake, verify insurance, and manage prior authorization requests.
Train sites on program requirements and assist with appeals through External Medical Review.
Inspire Medical Systems is a medical device company dedicated to treating Obstructive Sleep Apnea with an innovative FDA-approved device. The company values a people-first culture, offering excellent benefits, 401k matching, and flexible time off, and is committed to diversity and patient outcomes.
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.
Assists with patient medication management and facilitates medication renewal requests.
Acts as a liaison between providers, patients, and pharmacies for prescriptions and prior authorizations.
Monitors prior authorization status and updates relevant parties throughout the process.
Mass General Brigham is a not-for-profit integrated health care system supporting patient care, research, teaching, and community service. They employ a diverse team of professionals including doctors, nurses, and tech experts, fostering a collaborative culture focused on exceptional care.
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 the full Authorization process, from initial notification to determination and discharge, with detailed documentation in EMR and payer systems.
Verify patient eligibility and benefits, act as a liaison between hospital staff and health payers, and track pending authorizations for timely responses.
Maintain HIPAA compliance, escalate issues causing delays or denials, and manage workloads through accurate record keeping.
CorroHealth is a partner to healthcare providers, solving revenue cycle challenges through a mix of services, consulting, and technology. The company focuses on scalability and clinical expertise, building long-term careers by investing in employee development.
Collaborate with a multidisciplinary team to manage referrals, prior authorizations, and medical records for whole-person member care.
Apply knowledge of CPT/ICD-10 codes and insurance requirements to obtain authorizations, appeals, and follow up for positive outcomes.
Assist members with accessing services, provide personalized customer service, and track data to refine operational processes.
Oshi Health is a virtual digestive health practice transforming GI care with compassionate, multidisciplinary care and innovative technology. It is a mission-driven, remote-first startup focused on personalized care plans and building a diverse team.
Provide personalized onboarding and ongoing adherence support to patients and caregivers throughout their treatment journey.
Coordinate insurance coverage verification, reimbursement support, and financial assistance enrollment for eligible patients.
Serve as the primary point of contact for healthcare providers, resolving access barriers and ensuring seamless coordination with internal teams.
The partner company provides comprehensive non-clinical patient support for individuals managing rare and ultra-rare diseases. They foster a collaborative, patient-focused culture with a remote work environment and a commitment to improving healthcare access.
Verify patient insurance eligibility, benefits, and referral requirements prior to services.
Communicate coverage and financial responsibility to patients in a clear and empathetic manner.
Collaborate with cross-functional teams to improve patient access and reduce claim denials.
Oshi Health is a virtual digestive health practice that provides multidisciplinary care for chronic digestive conditions. It is a remote-first, mission-driven company focused on transforming GI care.
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.
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.
Contact patients by phone, email, and text to collect missing insurance information before appointments.
Verify insurance eligibility and benefits using Waystar, Availity, and other payer resources.
Document all insurance verification details accurately and assist patients with payment methods and forms.
Backpack Medical Group is a healthcare organization dedicated to making healthcare more accessible by ensuring accurate insurance and billing processes. They are a growing, mission-driven team focused on patient experience and collaboration.
Respond to provider inquiries with professionalism and accuracy, resolving questions on authorizations, claims, and general services.
Research and resolve claim and payment issues, verifying eligibility and benefits for providers.
Assist with provider enrollment, credentialing status, and network participation inquiries via phone, chat, email, and fax.
Curana Health is a national leader in value-based care for senior living communities and skilled nursing facilities, offering solutions to enhance health outcomes and streamline operations. Founded in 2021, the company serves 200,000+ seniors in 1,500+ communities across 32 states with a team of over 1,000 clinicians and support professionals, and was ranked #147 on the Inc. 5000 list.
Interpret, evaluate, and summarize information and datasets of varying sizes.
Determine benefit limits and secure insurance approvals for specialty infusion, oral chemotherapy and high-cost medications.
Serve as a resource to patients and staff regarding insurance and drug coverage questions.
Fred Hutchinson Cancer Center is an independent, nonprofit organization providing adult cancer treatment and groundbreaking research focused on cancer and infectious diseases. Based in Seattle, it is the only NCI-designated cancer center in Washington, employing a diverse workforce that values collaboration, compassion, and innovation.
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.
Verify and update patient demographic and insurance information with high accuracy.
Perform benefits and eligibility verification, and initiate authorization and pre-certification processes.
Communicate clearly with patients regarding financial responsibility, next steps, and required documentation.
Advocate Health is a nonprofit integrated health system formed from the combination of Advocate Aurora Health and Atrium Health, providing care under multiple regional brands. They employ 155,000 teammates across 69 hospitals and over 1,000 care locations, with a focus on clinical innovation, equitable care, and community benefit.