Review and process prior authorization requests for various medications.
Communicate prior authorization criteria to providers and act as a help desk.
Process requests via phone, fax, and web submission while maintaining HIPAA compliance.
Lumicera Health Services is a specialty pharmacy focused on optimizing patient well-being through transparency and stewardship. It fosters a diverse and creative work environment as part of the Navitus organization.
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.
Serve as the first point of contact, greeting patients and handling inbound calls.
Verify insurance, update demographics, and register patients in EMR (EPIC).
Document patient concerns, triage messages, and escalate emergent issues promptly.
U.S. Urology Partners provides urology and specialty services, including surgery and cancer treatment. It has over 50 offices across the East Coast and Midwest, with values of compassion, collaboration, respect, and accountability.
Reviews complex hospital service accounts to ensure completeness prior to patient arrival.
Verifies patient insurance, confirms benefits, and determines authorization requirements.
Initiates pre-certification and creates patient liability estimates.
Piedmont Healthcare is a healthcare system providing comprehensive medical services across Georgia. It is a large organization focused on patient-centered care and community health.
Serve as the primary financial contact for caregivers during onboarding, explaining insurance benefits and estimated costs.
Collaborate with care coordination and clinical teams to ensure a seamless onboarding experience.
Maintain accurate documentation of all caregiver interactions while upholding HIPAA and privacy standards.
Lyra Health is a leading provider of evidence-based mental health care, serving over 20 million people globally. The company has a collaborative culture focused on delivering transformative care through technology.
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.
Receive medical claims from healthcare providers or patients and verify supporting documentation to ensure completeness.
Interpret Explanation of Benefits (EOB) and CMS-1500 forms, then evaluate claims against program-specific business rules for approval or rejection.
Provide support to customer inquiries via phone, email, or fax while maintaining HIPAA compliance and meeting daily productivity goals.
IQVIA is a leading global provider of clinical research services, commercial insights, and healthcare intelligence to the life sciences and healthcare industries. With operations in over 100 countries, they cultivate a diverse, collaborative culture focused on improving patient outcomes.
Coordinates financial clearance activities including pre-registration, insurance verification, and authorizations to ensure timely access to care.
Maintains knowledge of payer requirements and works collaboratively with patients, providers, and insurance representatives to resolve issues.
Adheres to quality and productivity standards to support revenue cycle performance and patient access.
Boston Medical Center is a leading academic medical center dedicated to providing exceptional and equitable care to all. As a large health system, it fosters a strong sense of teamwork and support, and has been recognized as a top employer and best place to work.
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.
Manage patient intake processes by scheduling, rescheduling, and canceling appointments.
Verify and update patient demographics, insurance eligibility, and collect payments.
Process referrals and authorizations while responding to patient inquiries with professional communication.
A comprehensive healthcare network serving the Puget Sound region with a full spectrum of health care services, from routine wellness to complex disease management. It includes 10 hospitals and nearly 300 care sites, fostering a culture of compassionate care and shared purpose.
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.
Complete credentialing and re-credentialing applications for physicians, ancillary providers, and facilities with third-party payers and governmental programs.
Partner with client liaisons and payers to manage enrollment status, follow up on applications, and communicate updates to providers and clients.
BerryDunn is a professional services firm providing tax, advisory, and consulting services to businesses, nonprofits, and government agencies across the US. The firm is known for its client-centered, people-first culture and commitment to diversity, learning, and well-being.
Oversee billing codes and insurance authorizations to ensure accuracy and compliance.
Monitor authorization periods and proactively manage extensions or renewals.
Communicate with therapists, clinicians, and insurance companies to resolve authorization issues.
The company is a partner organization providing medical billing and authorization services for healthcare providers. It operates as a fully remote team with a focus on accuracy, compliance, and collaborative support.