Provide medication prior authorization support for assigned clinics using the Epic In Basket system.
Manage prior authorizations from clinic to pharmacy, including submission, tracking, and follow-up.
Communicate with clinics, pharmacies, and insurance payers to ensure timely approvals and patient access.
UnityPoint Health is a healthcare system delivering medical services across the Midwest. Recognized as a Top 150 Place to Work in Healthcare, it fosters a culture of belonging and supports team members with development and well-being.
Manage insurance authorizations for clients in PHP and IOP programs, including pre-certifications and concurrent reviews.
Verify benefits, obtain Single Case Agreements, and build medical necessity cases using ASAM, LOCUS, and CALOCUS criteria.
Maintain accurate authorization, denial, and SCA records and prepare appeals on denied authorizations.
AWA and PRC are dual behavioral health organizations operating PHP and IOP programs across South Florida. They exist to serve clients and families at their most critical moments.
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.
Determine patient qualification for financial assistance programs and payment arrangements using confidential financial information.
Verify insurance coverage, obtain authorizations, and provide price estimates for scheduled procedures.
Serve as a liaison between patients, providers, and internal departments to coordinate benefits and collect patient portions.
CommonSpirit Health is a large healthcare system with over 700 care sites across the U.S., serving nearly one in four Americans. The culture emphasizes compassion, community health, and employee commitment to a greater cause.
Facilitate medication approvals by communicating with insurance companies and healthcare providers regarding prior authorizations.
Navigate pharmacy systems to enter data, adjudicate claims, process refills, and document patient interactions.
Assist patients with insurance claims, medication access challenges, and promote adherence through phone support.
Shields Health Solutions is a healthcare company dedicated to helping patients access life-changing medications through prior authorization and financial assistance support. They foster a collaborative, patient-focused culture with opportunities for professional growth in a fully remote setting.
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.
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.
Verifies patient insurance coverage and submits prior authorizations to insurance plans.
Troubleshoots prior authorization submissions and prescription processing with healthcare providers.
Documents activities and works with Customer Support team to ensure patient success.
PHIL is a health-tech startup pioneering the first Software Therapy Deployment Platform for Specialty Pharmaceuticals. The company employs over 120 individuals and expects to double its employee base in the coming year.
Reviews insurance eligibility and coverage issues for patient appointments across practice sites.
Serves as the primary escalation contact for scheduling and practice teams on pre-visit and day-of-visit insurance questions.
Follows up post-visit to resolve PCP assignment and Coordination of Benefits discrepancies.
Bluebird Kids Health provides underserved communities with value-based pediatric primary care, aiming to help every child thrive through comprehensive services and around-the-clock support. The organization is a dynamic team focused on exceptional health outcomes and a rewarding environment for clinicians and staff.
Communicate with insurance companies and clinician offices to facilitate medication prior authorizations.
Assist patients with financial assistance resources and navigate pharmacy systems for claims processing.
Support medication adherence through direct patient communication and accurate documentation.
Shields Health Solutions is a healthcare solutions company specializing in specialty pharmacy services. The company fosters a collaborative culture focused on patient care and operational excellence.
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.
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.
Act as a liaison between patients, providers, and insurance companies to ensure accurate data collection and compliance.
Verify insurance benefits, eligibility, and prior authorization requirements for scheduled patients.
Notify patients of estimated liability and act as a financial counselor regarding insurance and payment options.
Vail Health is the world's most advanced mountain healthcare system, providing exceptional care through a 56-bed hospital and various outpatient services. It is a nonprofit organization committed to patient-centered care and community well-being.
Contribute directly to improving Provider experience through timely credentialing and enrollment.
Collaborate with cross-functional teams to support new payer launches and share operational insights.
Help educate credentialing associates as new processes and payers are introduced.
Rula is a remote-first company that makes mental health care more accessible by streamlining provider onboarding. The team values diversity, equity, and inclusion, fostering a culture of belonging.
Manage end-to-end credentialing and payer enrollment activities with minimal supervision.
Ensure provider readiness, accurate records, and compliant documentation across multiple systems.
Serve as a knowledgeable resource for less experienced team members and support cross-functional processes.
Our partner is a healthcare organization focused on credentialing and provider network management. They offer a mission-driven, inclusive environment with a focus on collaboration and continuous learning.
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.
Collect, verify, and maintain provider credentials such as education, licensure, and malpractice insurance.
Enroll providers with Medicare, Medicaid, and commercial insurance payers.
Maintain provider profiles in CAQH and track credential expiration dates for timely renewals.
Foodsmart is a telenutrition and foodcare solution backed by a network of Registered Dietitians, guiding 2.2 million members toward healthier food choices. The company is a remote-first team with a mission-driven culture and recently secured a $200 million investment from TPG's Rise Fund.
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.