access specialist

Ensemble Health Partners

<div>Thank you for considering a career at Ensemble!
Ensemble is a leading provider of technology-enabled revenue cycle management solutions for health systems, including hospitals and affiliated physician groups. They offer end-to-end revenue cycle solutions as well as a comprehensive suite of point solutions to clients across the country.
Ensemble keeps communities healthy by keeping hospitals healthy. We recognize that healthcare requires a human touch, and we believe that every touch should be meaningful. This is why our people are the most important part of who we are. By empowering them to challenge the status quo, we know they will be the difference!
O.N.E Purpose:<ul><li>
Customer Obsession: Consistently provide exceptional experiences for our clients, patients, and colleagues by understanding their needs and exceeding their expectations.</li><li>
Embracing New Ideas: Continuously innovate by embracing emerging technology and fostering a culture of creativity and experimentation.</li><li>
Striving for Excellence: Execute at a high level by demonstrating our &ldquo;Best in KLAS&rdquo; Ensemble Difference Principles and consistently delivering outstanding results.</li></ul>
The Opportunity:
ENTRY LEVEL CAREER OPPORTUNITY OFFERING:<ul><li>
Bonus Incentives</li><li>
Paid Certifications</li><li>
Tuition Reimbursement</li><li>
Comprehensive Benefits</li><li>
Career Advancement</li><li>
This position pays between $17.00 - $18.15 based on experience</li></ul>
***This position is an onsite role, and candidates must be able to work on-site at Bon Secours Westchester Emergency Center in Midlothian, VA.
We are searching for the next Patient Access Specialist champion. This role is responsible for performing admitting duties for all patients admitted for services at the hospital. They are responsible for performing these functions while meeting the mission and goals of the organization and all regulatory compliance requirements. The Representative will work within the policies and processes as they are being performed across the entire organization.
Job Responsibilities:<ul><li>
Patient Access staff are responsible for assigning accurate MRNs, completing medical necessity / compliance checks, providing proper patient instructions, collecting insurance information, receiving, and processing physician orders, and utilizing an overlay tool while providing excellent customer service as measured by Press Ganey.</li><li>
Operates the telephone switchboard to relay incoming, outgoing, and inter-office calls as applicable.</li><li>
They are to adhere to policies and provide excellent customer service in these interactions with the appropriate level of compassion.</li><li>
Patient Access staff will be held accountable for point of service goals as assigned.</li><li>
Patient Access staff are responsible for the utilization of quality auditing and reporting systems to ensure accounts are corrected. These activities may include accounts for other employees, departments, and facilities. Conducts audits of accounts and assures that all forms are completed accurate, timely to meet audit standards and provides statistical data to Patient Access leadership.</li><li>
Patient Access Staff are responsible for the pre-registration of patient accounts prior to patient visits. This may include inbound and outbound calling to obtain demographic, insurance, and other patient information including the patient financial liabilities including collecting point of service collections as well as past due balances including payment plan options.</li><li>
The Patient Access Staff explains general consent for treatment forms to the patient/guarantor/legal guardian, obtains necessary signatures and witness&rsquo;s name. Explains and distributes patient education documents, such as Important Message from Medicare, Important Message from Tricare, Observation Forms, MOON form, Consent forms, and all forms implemented for future services.</li><li>
Reviews eligibility responses in insurance verification system and appropriately selects the applicable insurance plan code, enters benefit data into system to support POS (Point of Service Collections) and billing processes to assist with a clean claim rate.</li><li>
Responsible for accurately screening of medical necessity using the Advanced Beneficiary Notice (ABN) software to inform Medicare patients of possible non-payment of test by Medicare and distribution of the ABN as appropriate. Responsible for distribution and documentation of other designated forms and pamphlets.</li></ul>
Experience:<ul><li>
1+ years of customer service experience</li><li>
Must be inquisitive and demonstrate openness to innovation including AI to explore better processes and ways to alleviate friction and improve patient and client experiences.</li></ul>
Minimum Education:<ul><li>High School Diploma/GED Required</li></ul>
Certifications:<ul><li>CRCR Required within 9 months of hire</li></ul>
Join an award-winning company
Five-time winner of &ldquo;Best in KLAS&rdquo; 2020-2022, 2024-2025
Black Book Research's Top Revenue Cycle Management Outsourcing Solution 2021-2024
22 Healthcare Financial Management Association (HFMA) MAP Awards for High Performance in Revenue Cycle 2019-2024
Leader in Everest Group's RCM Operations PEAK Matrix Assessment 2024
Clarivate Healthcare Business Insights (HBI) Revenue Cycle Awards for strong performance 2020, 2022-2023
Energage Top Workplaces USA 2022-2024
Fortune Media Best Workplaces in Healthcare 2024
Monster Top Workplace for Remote Work 2024
Great Place to Work certified 2023-2024<ul><li>
Innovation</li><li>
Work-Life Flexibility</li><li>
Leadership</li><li>
Purpose + Values</li></ul>
Bottom line, we believe in empowering people and giving them the tools and resources needed to thrive. A few of those include:<ul><li>
Associate Benefits &ndash; We offer a comprehensive benefits package designed to support the physical, emotional, and financial health of you and your family, including healthcare, time off, retirement, and well-being programs.</li><li>
Our Culture &ndash; Ensemble is a place where associates can do their best work and be their best selves. We put people first, last and always. Our culture is rooted in collaboration, growth, and innovation.
</li><li>Growth &ndash; We invest in your professional development. Each associate will earn a professional certification relevant to their field and can obtain tuition reimbursement.</li><li>
Recognition &ndash; We offer quarterly and annual incentive programs for all employees who go beyond and keep raising the bar for themselves and the company.</li></ul>
Ensemble is an equal employment opportunity employer. It is our policy not to discriminate against any applicant or employee based on race, color, sex, sexual orientation, gender, gender identity, religion, national origin, age, disability, military or veteran status, genetic information or any other basis protected by applicable federal, state, or local laws. Ensemble also prohibits harassment of applicants or employees based on any of these protected categories.
Ensemble provides reasonable accommodations to qualified individuals with disabilities in accordance with the Americans with Disabilities Act and applicable state and local law. If you require accommodation in the application process, please contact TA@ensemblehp.com.
This posting addresses state specific requirements to provide pay transparency. Compensation decisions consider many job-related factors, including but not limited to geographic location; knowledge; skills; relevant experience; education; licensure; internal equity; time in position. A candidate entry rate of pay does not typically fall at the minimum or maximum of the role&rsquo;s range.
Employment Disclaimers &ndash; Ensemble</div>

Patient Access Specialist

Talented Medical Solutions

<div>Job Summary
RRT Vascular Access Specialist
Talented Medical Solutions
Contract
In-Office | Mesa, AZ, United States
VA-BC or CPUI certification preferred, ACLS required.
Weekends, Holidays and Float as needed per department guidelines.
18:00 - 06: 30
36HRS Guaranteed
05/18 - 08/15 
Responsibilities<ul><li>
Perform vascular access procedures as an RRT Vascular Access Specialist with high accuracy.</li><li>
Maintain accurate patient records and document procedures in the EMR promptly.</li><li>
Develop and manage a territorial pipeline to forecast procedure needs and revenue.</li><li>
Meet or exceed monthly and quarterly procedural targets and productivity metrics.</li><li>
Maintain compliance with regulatory standards, infection control, and safety protocols.</li><li>
Collaborate with clinical teams to ensure seamless patient care and handoffs.</li><li>
Participate in ongoing professional development to advance clinical and technologic skills.</li><li>
Educate patients and caregivers on vascular access procedures, aftercare, and safety.</li><li>
Identify opportunities for process improvements to enhance efficiency and outcomes.</li><li>
Represent the company professionally in the field with a focus on building trust and credibility.</li><li>
Provide timely escalation and reporting of equipment or supply needs to maintain operations.</li></ul> 
Experience/Qualifications<ul><li>
Strict adherence to infection control, safety protocols, and regulatory standards.</li><li>
RRT licensed or eligible for licensure in relevant state.</li><li>
Proven experience performing vascular access procedures in an acute or outpatient setting.</li><li>
Meet/exceed monthly and quarterly procedural targets and productivity metrics.</li><li>
Accurate EMR documentation with timely procedure coding and charting.</li><li>
Territory management: build pipeline, forecast demand, and drive revenue growth.</li><li>
Ongoing professional development and hands-on learning of new technologies.</li><li>
Collaborate with clinicians for smooth patient handoffs and care coordination.</li><li>
Educate patients and caregivers on procedures, aftercare, and safety.</li><li>
Identify process improvement opportunities to improve efficiency and outcomes.</li><li>
Escalation and reporting of equipment or supply needs to operations promptly.</li><li>
Professional field representation with strong communication and credibility.</li><li>
On-site at designated locations with reliable travel within territory.</li></ul> 
What's in it for you? (Salary, Commissions &amp; Benefits)<ul><li>
On-site position based in Mesa, AZ &mdash; collaborate in person with your team and enjoy a dedicated workplace environment.</li><li>
Competitive base salary &mdash; clear, straightforward compensation through a guaranteed base pay.</li></ul>
#Workwolf</div>

RRT Vascular Access Specialist

UCHealth

<div>Location: UCHealth UCHlth Med Ctr of the Rockies, US:CO:Loveland 
 
Department: SYS Patient Access 
 
Work Schedule: Full Time, 64.00 hours per pay period (2 weeks)
 
 
Shift: Evenings
 
 
Pay: $19.67 - $25.57 / hour. Pay is dependent on applicant's relevant experience 
 
This position is an onsite role and does not offer a hybrid or remote option 
 
Summary: 
 
Provides receptionist, registration, and clerical duties associated with registering patient for services. 
 
Responsibilities: 
<ul><li>
Meets with patient and/or patient's caregiver to exchange necessary information and documentation. Provides explanation of visit, instructions, and addresses concerns and questions.</li><li>
Verifies insurance benefits and obtains pre-certification/authorization as necessary</li><li>
Escort and transport patients and visitors within facility, which may include a wheelchair or oxygen tank.</li><li>
Determines and accepts required payments, including co-pays and deductibles, or refers to financial counselors for follow up. Ensures that all necessary demographic, billing, and clinical information is obtained and entered in the registration system with timeliness and accuracy.</li><li>
Within scope of job, requires critical thinking skills, decisive judgement and the ability to work with minimal supervision. Must be able to work in a fast-paced environment and take appropriate action.</li></ul> 

Requirements: 
<ul><li>
High school diploma or GED.</li></ul> 
Employees are our number one asset. 
 
UCHealth promotes a culture that invests in professional success and personal well-being through a comprehensive total rewards program. * 
 
Recognition 
<ul><li>
Performance bonus: UCHealth offers a 3-Year Incentive Bonus to recognize employee contributions to our success in quality, patient experience, organizational growth, financial goals and tenure. The bonus accumulates annually each October and is paid out in October during the third year of employment.</li><li>
Performance-based pay increase: The Annual Merit Pay Increase recognizes work performance that meets or consistently exceeds performance standards documented through UCHealth's established evaluation process and accounts for increased experience, skills and cost of living.
</li><li>Market reviews: All UCHealth positions are reviewed annually to ensure UCHealth base pay aligns with market standards. Base pay rates are adjusted as needed to stay market competitive.
</li></ul> 
Health and well-being 
<ul><li>
Medical, dental and vision coverage.</li><li>
Access to 24/7 mental health and well-being support for employees and dependents.</li><li>
Discounted gym memberships and fitness resources.</li><li>
Free Care.com membership.</li><li>
Voluntary benefits such as accident insurance, critical illness insurance, group legal plan, identity theft protection, pet insurance, auto and home insurance, and employee discount programs.</li><li>
Time away from work: Paid time off (PTO), paid family and medical leave (inclusive of Colorado FAMLI), leaves of absence.</li><li>
Employer-provided basic life and accidental death and dismemberment coverage with buy-up coverage options.</li><li>
Employer-provided short-term disability and long-term disability with a buy-up coverage option.</li></ul> 
Retirement and savings 
<ul><li>
403(b) plan with employer matching contribution.</li><li>
Additional 457(b) plan may be available.</li><li>
Flexible spending accounts for health care and dependent day care; health savings account available when enrolled in high-deductible (HD) medical plan.</li></ul> 
Education and career growth 
<ul><li>
UCHealth provides access to academic degrees and certificate programs to promote professional and personal growth.</li><li><ul><li>
Up to 100% of tuition, books and fees paid for by UCHealth for specific educational degrees.
</li><li>Other programs may qualify for up to $10,000/year pre-paid by UCHealth or up to $5,250/year in the form of tuition reimbursement.
</li></ul></li><li>Access to LinkedIn Learning, which offers thousands of virtual courses and seminars, and internal professional development opportunities.
</li><li>Employees have access to free assistance navigating the Public Service Loan Forgiveness program and submitting their federal student loans for forgiveness.</li></ul> 
<ul><li>Eligibility for some programs is based on an employee's scheduled work hours.
</li></ul> 
We improve lives. In big ways through learning, healing, and discovery. In small, personal ways through human connection. But in all ways, we improve lives.
 
 
UCHealth always welcomes talent. This position will be open for a minimum of three days and until a top applicant is identified. 
 
UCHealth recognizes and appreciates the rich array of talents and perspectives that equal employment and diversity can offer our institution. As an equal opportunity employer, UCHealth is committed to making all employment decisions based on valid requirements. No applicant shall be discriminated against in any terms, conditions or privileges of employment or otherwise be discriminated against because of the individual's race, color, national origin, language, culture, ethnicity, age, religion, sex, disability, sexual orientation, gender, veteran status, socioeconomic status, or any other characteristic prohibited by federal, state, or local law. UCHealth does not discriminate against any qualified applicant with a disability as defined under the Americans with Disabilities Act and will make reasonable accommodations, when the do not impose an undue hardship on the organization. 
 
Who We Are (uchealth.org)</div>

Patient Access Registration Specialist

Conduit Health Partners

<div>The Behavioral Health Access Specialist coordinates the acceptance and throughput of behavioral health patients meeting criterial for inpatient admission from one facility to another in a call center environment. This employee performs functions based on defined standards of performance and practice to meet or exceed operational expectations related to transfer center/ access center services. The employee works collaboratively with internal and external partners to facilitate patient access according to mental health needs. The Behavioral Health Access Specialist will foster relationships with referring and receiving facility physicians and employees as well as community agencies in representation of Conduit Health Partners' Mission and Values.
We currently have opportunities available across all shifts - days, evenings, and nights - with both full-time and part-time positions. Schedules are set and follow a six-week rotation, which includes an every-other-weekend requirement.
There is also an on-call component and a rotating holiday requirement for all positions. Once you're placed into a schedule, you'll be expected to work that set schedule for at least six months before any schedule change request is considered.
Please note that while schedule change requests are reviewed every six weeks, they are not guaranteed and are evaluated based on our established standard operating procedures.
During orientation, you will follow the schedule of your assigned preceptor. Leadership will make every effort to match you with a preceptor on your designated shift (days, evenings, or nights), but final assignments are based on preceptor availability and may not always align perfectly with your shift preference.<ul><li>Hours subject to change based on need of operations</li></ul>
Essential Job Functions
<ul><li>Coordinates functions in order to support destination placement for the mental health patient meeting criteria for inpatient admission from potential referral sources to include but not limited to hospitals, clinics, extended care facilities, and physician offices to initiate acceptance and expedite decision making relative to potential access.</li><li>
Proficient in EHR data entry, telephony systems, office systems as required to support operations, ensuring accurate, timely data entry, protection of PHI. Demonstrates the ability to process resulting level of care needs utilizing critical thinking, clinical decision making, and acquired knowledge skills to facilitate placement as requested by referring provider or entity.</li><li>
Uses problem-solving skills to make recommendations that promotes the best potential patient outcome based on clinical information, patient and / or physician preferences, and the capability / capacity of both transferring and receiving facilities. Communicates an accurate clinical presentation of the patient for consulting or accepting provider and caregivers</li><li>
Utilizes effective and professional communication to act as liaison on behalf of patient and client facilities between physicians, hospital staff, and outside agencies.</li><li>
Demonstrates knowledge of regulatory components to include but not limited to EMTALA, Ethics and Compliance, quality initiatives, and HIPAA.</li><li>
Works directly with providers and other healthcare providers at each client facility as well as client footprint facility to ensure timely acceptance and access to appropriate level of care/bed assignment using applicable workflows.</li><li>
Reports risks related to safety, compliance as well as operational inefficiencies using defined Chain of Command in a timely manner and offers recommendations for resolution or improvement if applicable.</li><li>
Participates in process improvement, professional development and peer review</li><li>
Responsible for other tasks and analysis as requested /directed.</li></ul>
This document is not an exhaustive list of all responsibilities, skills, duties, requirements, or working conditions associated with the job. Employees may be required to perform other job-related duties as required by their supervisor, subject to reasonable accommodation.
Licensing/Certification
Active multistate/compact registered nurse (LPN) licensure - Required (compact licensure applicable based on state of residence. If unable to obtain compact licensure due to state of residence, must have active License-Practical Nursing (LPN)) or Licensed Social Worker (LSW) &ndash; Required
Education
Vocational Training, Licensed Practical Nurse (LPN) (required) or Bachelors degree, Social Work (required)
Work Experience
1 year of mental health intake (required)
Healthcare contact center (preferred) 
Training
Epic electronic health record (preferred)
Genesys contact center (preferred)
Office Setting<ul><li>
Must have a designated workspace with a locked door, per HIPAA regulations.</li><li>
Associates are encourages to also identify a secondary work location, meeting HIPAA regulations in case of power outages as well.</li></ul>
IT Requirements
Minimum internet speed of primary and secondary work locations is:<ul><li>
Download speed of 100Mpbs</li><li>
Upload speed of 20Mbps</li></ul>
Skills<ul><li>
Customer Service oriented</li><li>
Microsoft Office Tools (Outlook, MS Teams, Excel, Word, etc.)
</li><li>Technology savvy
</li><li>Multitasking
</li><li>Review &amp; interpret patient transfer case information.
</li><li>Escalate/Inform regarding patient status changes.
</li><li>Record tasks and conversations regarding patient transfer.
</li><li>Attention to detail.</li><li>
Acceptance of authority</li><li>
Critical thinking</li><li>
Communication with clinical care team members
</li><li>Teamwork</li><li>
Active listening</li><li>
Relationship building</li><li>
Agility and adaptability
</li><li>Excellent oral and written communication skills
</li><li>Performance driven.
</li></ul>As a Bon Secours Mercy Health associate, you're part of a Mission that matters. We support your well-being&mdash;personally and professionally. Our benefits are built to grow with you and meet your unique needs, every step of the way.

What we offer
<ul><li>Competitive pay, incentives, referral bonuses and 403(b) with employer contributions (when eligible)</li>
<li>Medical, dental, vision, prescription coverage, HSA/FSA options, life insurance, mental health resources and discounts</li>
<li>Paid time off, parental and FMLA leave, short- and long-term disability, backup care for children and elders</li>
<li>Tuition assistance, professional development and continuing education support</li>
</ul>Benefits may vary based on the market and employment status.
All applicants will receive consideration for employment without regard to race, color, national origin, religion, sex, sexual orientation, gender identity, age, genetic information, or protected veteran status, and will not be discriminated against on the basis of disability. If you'd like to view a copy of the affirmative action plan or policy statement for Bon secours Mercy Health &ndash; Youngstown, Ohio or Bon Secours &ndash; Franklin, Virginia; Petersburg, Virginia; and Emporia, Virginia, which are Affirmative Action and Equal Opportunity Employers, please email recruitment@mercy.com. If you are an individual with a disability and would like to request a reasonable accommodation as part of the employment selection process, please contact The Talent Acquisition Team at recruitment@mercy.com</div>

Licensed Practical Nurse (LPN) - Behavioral Health Specialist - Conduit Health Partners

CareMed Specialty Pharmacy

<div>
 
 Pharmacy Prior Authorization Specialist &ndash; CareMed Specialty Pharmacy
 
 
 
 
 Houston, TX
 
 |
 
 Full-Time
 
 |
 
 Starting at $23.00/hr and up
 
 
 
 
 Sign-On Bonus:
 
 $5,000 for employees starting before July 31, 2026.
 
 
 
 Join a mission-driven team making a difference in the lives of cancer patients.
 
 
 
 CareMed Specialty Pharmacy is seeking a
 
 Pharmacy Prior Authorization Specialist
 
 to join our dedicated team in Houston, TX. This is a full-time position ideal for candidates local to the area.
 
 Remote work possible after initial on-site training.
 
 
 
 
 Company Benefits
 
 
 
 <ul>
 <li>
 Medical; Dental; Vision
 </li>
 <li>
 401k with a match
 </li>
 <li>
 Paid Time Off and Paid Holidays
 </li>
 <li>
 Tuition Reimbursement
 </li>
 <li>
 Quarterly Incentive Bonus
 </li>
 <li>
 Paid Volunteer Day
 </li>
 <li>
 Referral Incentive Program
 </li>
 <li>
 Company Paid Life Insurance; and Short/Long-Term Disability
 
 
 </li>
 </ul>
 
 Why Join Us?
 
 
 
 <ul>
 <li>
 A career with purpose: Help patients access life-saving medications.
 </li>
 <li>
 Supportive culture: We value teamwork, respect, integrity, and passion.
 </li>
 <li>
 Growth opportunities: We invest in your professional and personal development.
 
 
 </li>
 </ul>
 
 What You&rsquo;ll Do
 
 
 
 The Pharmacy Prior Authorization Specialist will ensure patients receive the medication that requires pre-authorizations from insurance carriers by receiving prescriptions, addressing and rectifying rejected claims and conducting necessary third party authorization requests.
 
 
 
 How You&rsquo;ll Do This
 
 
 
 <ul>
 <li>
 Manage prior authorization requests and appeals with insurance carriers.
 </li>
 <li>
 Collaborate with physicians, pharmacists, and other departments.
 </li>
 <li>
 Ensure HIPAA compliance while handling sensitive patient information.
 </li>
 <li>
 Maintain accurate documentation of authorization details.
 </li>
 <li>
 Proactively monitor and renew expiring authorizations.
 
 
 </li>
 </ul>
 
 Required
 
 
 
 
 What You Bring
 
 
 
 <ul>
 <li>
 High School Diploma or GED
 </li>
 <li>
 1+ years of pharmacy or prior authorization experience
 </li>
 <li>
 Registration with Board of Pharmacy (as required by state law)
 </li>
 <li>
 Strong communication, organizational, and customer service skills
 </li>
 <li>
 Self-motivated, organized, detail-oriented, and adaptable to changing priorities
 </li>
 <li>
 Knowledge of pharmacy terminology, pharmacy insurance claims, Medicare, Medicaid, and commercial insurance, pharmacy test claim and NCPDP claim rejection resolution, coordination of benefits, NDC medication billing, experience with CoverMyMeds
 
 
 </li>
 </ul>
 
 Preferred
 
 
 
 <ul>
 <li>
 Associate degree or Certified Pharmacy Technician (PTCB)
 </li>
 <li>
 3+ years of experience in pharmacy or prior authorizations
 </li>
 <li>
 Specialty pharmacy experience
 
 
 </li>
 </ul>
 
 Ready to make a meaningful impact? Apply today and help us better the lives of those battling cancer.
 
 
 
 
 Company Values: Teamwork, Respect, Integrity, Passion
 
</div>

Prior Authorization Specialist

<div><div><div>Pharmacy Prior Authorization Specialist &ndash; CareMed Specialty Pharmacy 
Waltham, MA | Full-Time | Starting at $23.00/hr and up</div>
<div></div><div>Sign-On Bonus: $5,000 for employees starting before July 31, 2026.</div>
<div></div><div>Join a mission-driven team making a difference in the lives of cancer and rare disease patients.</div>
<div></div><div>CareMed Specialty Pharmacy is seeking a Pharmacy Prior Authorization Specialist to join our dedicated team in Waltham, MA. This is a full-time position ideal for candidates local to the area. Remote work possible after initial on-site training.</div>
<div></div><div>Company Benefits</div>
<ul><li>Medical; Dental; Vision</li>
<li>401k with a match</li>
<li>Paid Time Off and Paid Holidays</li>
<li>Tuition Reimbursement</li>
<li>Quarterly Incentive Bonus</li>
<li>Paid Volunteer Day</li>
<li>Referral Incentive Program</li>
<li>Company Paid Life Insurance; and Short/Long-Term Disability</li>
</ul> <div>Why Join Us?</div>
<ul><li>A career with purpose: Help patients access life-saving medications.</li>
<li>Supportive culture: We value teamwork, respect, integrity, and passion.</li>
<li>Growth opportunities: We invest in your professional and personal development.</li>
</ul><div>What You&rsquo;ll Do</div>
<div>The Pharmacy Prior Authorization Specialist will ensure patients receive the medication that requires pre-authorizations from insurance carriers by receiving prescriptions, addressing and rectifying rejected claims and conducting necessary third party authorization requests.</div>
<div></div><div>How You&rsquo;ll Do This</div>
<ul><li>Manage prior authorization requests and appeals with insurance carriers.</li>
<li>Collaborate with physicians, pharmacists, and other departments.</li>
<li>Ensure HIPAA compliance while handling sensitive patient information.</li>
<li>Maintain accurate documentation of authorization details.</li>
<li>Proactively monitor and renew expiring authorizations.</li>
</ul> <div>What You Bring</div>
<div>Required:</div>
<ul><li>High School Diploma or GED</li>
<li>1+ years of pharmacy or prior authorization experience</li>
<li>Registration with Board of Pharmacy (as required by state law)</li>
<li>Strong communication, organizational, and customer service skills</li>
<li>Self-motivated, organized, detail-oriented, and adaptable to changing priorities</li>
<li>Knowledge of pharmacy terminology, pharmacy insurance claims, Medicare, Medicaid, and commercial insurance, pharmacy test claim and NCPDP claim rejection resolution, coordination of benefits, NDC medication billing, experience with CoverMyMeds</li>
</ul><div>Preferred:</div>
<ul><li>Associate degree or Certified Pharmacy Technician (PTCB)</li>
<li>3+ years of experience in pharmacy or prior authorizations</li>
<li>Specialty pharmacy experience</li>
</ul><div>Ready to make a meaningful impact? Apply today and help us better the lives of those battling cancer.</div></div></div>

Riverview Health

<div>
 
 Job Summary
 
 
 
 The Authorization Specialist is responsible for ensuring that payers are prepared to reimburse Riverview Health for scheduled services in accordance with the payer-provider contract. The Specialist contacts payers to request service authorization and may collect clinical, financial and/or demographic information from clinics, hospital departments and/or patients as needed.
 
 
 
 Job Responsibilities
 
 
 
 <ul>
 <li>
 Verifies patients&rsquo; insurance and benefits information
 </li>
 <li>
 Obtains prior authorizations from third-party payers in accordance with payer requirements. Identifies patients who will need to receive Medicare Advance Beneficiary Notices of Noncoverage (ABNs).
 </li>
 <li>
 Contacts patients to gather demographic and insurance information as needed, and updates patient information within the EMR as necessary.
 </li>
 <li>
 Works with other departments to gather the clinical information required by the payer to authorize services. Maintains accurate records of authorizations within EMR.
 </li>
 <li>
 Develops price estimates for patient out-of-pocket responsibility.
 </li>
 <li>
 Refers accounts to financial counseling as needed if authorization is not obtained. Works with business office staff to support appeal efforts for authorization-related denials.
 </li>
 <li>
 Reviews surgery schedules to ensure Medicare patients with IP-only procedures have the appropriate authorization and order.
 </li>
 <li>
 Complies with HIPAA regulations, as well as Riverview Health policies and procedures regarding patient privacy and confidentiality.
 </li>
 <li>
 Maintains professional tone at all times when communicating with patients and payer representatives.
 </li>
 <li>
 Coordinates re-education to practices or hospital departments when orders are incorrect or not supported by the given diagnosis.
 </li>
 <li>
 Performs other duties as requested.
 
 
 </li>
 </ul>
 
 Education Requirements
 
 
 
 <ul>
 <li>
 Minimum: Associate degree in healthcare or business administration and/or related coursework, or comparable experience
 </li>
 <li>
 Preferred: Experience in Epic
 
 
 </li>
 </ul>
 
 Experience Requirements
 
 
 
 <ul>
 <li>
 Minimum: Two years of experience in a healthcare setting performing related tasks
 </li>
 <li>
 Preferred: Five years of experience in a healthcare setting performing related tasks
 
 
 </li>
 </ul>
 
 License/Certification Requirements
 
 
 
 <ul>
 <li>
 None
 
 
 </li>
 </ul>
 Education
 
 
 
 Required
 
 
 
 <ul>
 <li>
 Associates or better in Other
 
 
 </li>
 </ul>
 Equal Opportunity Employer
 
 
 This employer is required to notify all applicants of their rights pursuant to federal employment laws. For further information, please review the Know Your Rights notice from the Department of Labor.
</div>

Authorization Specialist

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5285 access specialist jobs Near Me

Patient Access Specialist

RRT Vascular Access Specialist

Patient Access Registration Specialist

Licensed Practical Nurse (LPN) - Behavioral Health Specialist - Conduit Health Partners

Prior Authorization Specialist

Prior Authorization Specialist

Authorization Specialist