authorization coordinator

The Medical Team

<div><div>THE MEDICAL TEAM is a top-ranked healthcare services company, in business since 1978 under the same ownership and management. We pride ourselves on program innovation, recognition of individual excellence, and a strong commitment to top notch patient care.
</div><div>We are looking for an enthusiastic, detail-oriented individual with strong communication, interpersonal and customer service skills to join our TEAM in the Livonia, Michigan area.
</div><div>Duties and Responsibilities:
</div><ul><li>Obtain, follow up and track authorizations and problem solve as needed.
</li><li>Communicate with insurance companies to verify Insurance eligibility and requirements
</li><li>Follow-up on missing or inaccurate information.
</li><li>Ensures compliance with all state, federal regulatory requirements.
</li><li>Establishes and maintains positive working relationships with current potential referral sources.
</li><li>Perform other duties as assigned.
</li></ul><div>Qualifications/Experience:
</div><ul><li>Excellent customer service especially over the phone
</li><li>Knowledge of CPT's and ICD-10 codes
</li><li>Efficient with multiple software systems
</li><li>Proficient and attention to detail for data entry
</li><li>Ability to work well under pressure and address time sensitive deadlines
</li><li>Excellent communication skills
</li><li>Experience dealing with multiple insurance companies for verification of insurance and obtaining pre-authorizations for health care.
</li><li>Ability to work as a team member including sharing an office and work load with others in close proximity, assisting and prioritizing as a team to accomplish the goals of the team
</li><li>Email and e-faxing working with copy machines
</li><li>Knowledge of software systems Kinnser preferred</li></ul></div>

Authorization Coordinator

Neurology of the Rockies

<p>Neurology of the Rockies is looking to add an Insurance Authorization Coordinator to our growing team! Ideal candidate will be very detail oriented with excellent organizational and documentation skills.</p><p>This position is full time. We offer competitive pay. Our full-time employees are offered medical, vision and dental insurance, 4% matching 401k and paid time off. We promote healthy work/life balance with annual company sponsored team building events.</p><p>Duties include but not limited to:</p><ul><li>Obtaining authorization for specialty medication</li><li>Ordering medication through specialty pharmacies</li><li>Tracking inventory of medication supply</li><li>Verifying insurance benefits and eligibility</li><li>Discussing patient financial responsibility and collecting monies owed</li><li>Scheduling appointments</li></ul><p>If this sounds like it may be a good fit, please submit your resume with salary requirements.</p><p>We look forward to meeting with you!</p><p>Pay: $18.00 - $23.00 per hour</p><p>Benefits:</p><ul><li>401(k) matching</li><li>Dental insurance</li><li>Health insurance</li><li>Paid time off</li><li>Vision insurance</li></ul><p>Work Location: In person</p>

Medical Office Insurance Authorization Coordinator

Hospital Authority of Miller County

<div>Description:
<p><b>
JOB SUMMARY:</b></p><p>
The Patient Access Authorization Scheduler Coordinator will be responsible for completing accurate pre-registration, registration, and scheduling of hospital patients. Other duties will consist of verifying and documenting all insurance coverage, obtaining pre-certifications, authorizations, answering any questions and explaining policies clearly, verifying pre-authorization for exams, advising patients of their scheduled procedure estimated patient responsibility and other miscellaneous duties.</p><p><b>
GENERAL REQUIREMENTS:</b></p><ul><li>
Performs all job responsibilities in alignment with the mission and vision of the organization.</li><li>
Performs other duties as required and completes all job functions as per departmental policies and procedures.</li><li>
Maintains current knowledge in present areas of responsibility (i.e., self-education, attends ongoing educational programs).</li><li>
Attends staff meetings and completes mandatory in-services and requirements and competency evaluations on time.</li><li>
Wears protective clothing and equipment as appropriate.</li></ul><p><b>
GENERAL SKILLS:</b></p><ul><li>
Ability to communicate in English, both verbally and in writing.</li><li>
Additional languages preferred.</li><li>
Strong written and verbal skills.</li><li>
Basic Computer Skills</li></ul><p><b>
WORKING CONDITIONS:</b></p><ul><li>
General environment: Works in a well-lighted, air-conditioned area, with moderate noise levels.</li><li>
May be exposed to high noise levels and bright lights.</li><li>
May be exposed to limited hazardous substances or body fluids, or infectious organisms.</li><li>
May be required to change from one task to another or different nature without loss of efficiency or composure.</li><li>
Periods of high stress and fluctuating workloads may occur.</li><li>
May be scheduled as needed including overtime.</li></ul><p><b>
PHYSICAL REQUIRMENTS &amp; DEMANDS:</b></p><ul><li>
Have near normal hearing: Hear alarms/telephone/normal speaking voice.</li><li>
Have near normal vision: Clarity of vision (both near and far), ability to distinguish colors.</li><li>
Have good manual dexterity.</li><li>
Have good eye-hand foot coordination.</li><li>
Ability to perform repetitive tasks/motion.</li><li>
Continuously within shift (67-100%): Standing, Walking.</li><li>
Frequently within shift (34-66%): Bending/Stooping, Pushing/Pulling, Lift/carry up to 20lbs, Lift/carry greater than 20 lbs. with assistance.</li><li>
Occasionally within shift (1-33%): Sitting, Climbing, Twist at waist, Lift/Carry greater than 50 lbs. with assistance, Reaching above shoulder.</li></ul><p><b>
MISSION STATEMENT:</b></p><p><b>
QUALITY HEALTHCARE:</b> In our continuing effort to enhance the quality of life for the communities we serve, the Hospital Authority of Miller County is committed to the delivery of superior, safe, cost-effective healthcare through the provisions of education prevention, diagnosis and treatment.</p><p><b>
JOB SPECIFIC COMPETENCIES:</b></p><ul><li>
Schedule Therapy Procedures and other procedures, as necessary.</li><li>
Answer telephones in a professional manner; directs calls as appropriate.</li><li>
Contacts all designated personnel in the event of any scheduling changes such as cancellations, additions, or time changes.</li><li>
Pre-register 98% of all scheduled patients a minimum of three (3) business days in advance of their arrival.</li><li>
Obtain, validate, and accurately enter in the computer system, the patient&rsquo;s demographic and insurance information while maintaining an acceptable accuracy rate (95% plus) as evidenced by routine quality review. Information may be obtained from the physician&rsquo;s office or the patient via direct contact, telephone, or fax.</li><li>
Identify and escalate complex authorization issues to senior team members.</li><li>
Obtain signatures on all necessary forms and documents required by hospital and by law.</li><li>
Ensure MSP Questionnaire is completed for every Medicare registration.</li><li>
Work closely and cooperatively with the physician office staff, schedulers and other hospital departments to schedule and prepare the required information before the patient&rsquo;s arrival.</li><li>
Utilize online programs to verify insurance eligibility and benefits, documenting findings on the patient account. Assist by contacting the insurance company for pre-authorizations and pre-certifications as required prior to patient receiving service.</li><li>
Collect co-payment, deductible or co-insurance previously identified by the Insurance Verification Specialist on as indicated on the insurance card or online eligibility system, when the patient arrives for service.</li><li>
Log cash collected, generate receipts, and always maintain balanced cash.</li><li>
Meet monthly cash collection goals as determined collaboratively by Department Director and Manager.</li><li>
Responsible for knowing the functions of the phone system to professionally manage incoming calls, appropriately transfer calls, and assist with any internal calls when asked to do so by the Department Director, Manager or Supervisor.</li><li>
Consistently demonstrate premier customer service and communication skills with all internal and external customers/contacts and ensure the patient and their family members have the best hospital encounter possible.</li><li>
Meet established quality and productivity standards for self and for the team.</li><li>
Anticipate and adapt to change (e.g., hospital policy changes, operational/procedures, insurance changes) in a positive manner.</li><li>
Foster and reinforce team-based results.</li><li>
Adhere to time and attendance standards as outlined in the Human Resource Policy manual. Provide proper notification of absence or tardiness within established departmental time limits.</li><li>
Ensure patient confidentiality adhering to HIPAA guidelines.</li><li>
Demonstrate the knowledge, skills, and abilities (competencies) to perform the duties outlined above annually in the form of a test or as evidenced by daily quality review and direct observation of the Team Lead and the Department Director.</li><li>
Track and monitor productivity as requested.</li><li>
Keep Department Director&rsquo;s (including Radiology) apprised of any delays in the authorization process.</li><li>
Remain current on scheduling, registration, insurance verification, and other patient registration processes to cover in the absence of other team members.</li><li>
Perform other duties as assigned.</li><li>
Informs supervisor/manager of problematic situations and demonstrates ability to support recommendations/decisions.</li><li>
Ability to maintain operational knowledge of all insurance requirements necessary to achieve optimal reimbursement.</li></ul><p><b>
PROFESSIONAL REQUIREMENTS:</b></p><ul><li>
Follows Code of Conduct policy.</li><li>
Adheres to dress code; appearance is neat and clean.</li><li>
Completes annual educational requirements.</li><li>
Maintains regulatory requirements.</li><li>
Maintains patient confidentiality at all times.</li><li>
Reports to work on time and as scheduled; completes work within designated time.</li><li>
Wears identification when on duty; uses computerized time clock system correctly.</li><li>
Completes in-services and returns in a timely fashion.</li><li>
Attends annual review and/or skills fair and department in-services, as scheduled.</li><li>
Attempts to end conversations and other interactions in a positive manner; leaves others with a good impression of the Hospital Authority of Miller County and its employees.</li><li>
Complies with all organizational policies regarding ethical business practices.</li><li>
Communicates the mission statement of the organization.</li></ul><p><b>
GUEST RELATIONS STANDARDS:</b></p><ul><li>
(All guest relation violations are subject to disciplinary action up to and including termination):</li><li>
Always treat others in a friendly, helpful manner.</li><li>
Refers co-workers to proper sources when unable to provide an answer.</li><li>
Interacts with others in a professional and friendly manner.</li><li>
Takes interest in others and always gives full cooperation to fellow workers.</li><li>
Always maintains an open line of communication with other departments.</li><li>
Thoroughly familiar with the hospital and the services it offers.</li></ul><p><b>
OTHER:</b></p><ul><li>
Responsibility to Report: It is the responsibility of every employee of HAMC to comply with federal, state and local laws and regulations, as well as, HAMC Policies and Procedures. Every employee is help accountable to participate in, comply with and report concerns to his or her supervisor or the Compliance Officer if illegal or unethical behavior is suspected.</li><li>
As an employee of HAMC, you have been granted user access to applicable ePHI systems based on your position. This user or role-based access is intended to give you the minimum necessary access to perform your job function(s) only and should be used only as applicable.</li></ul><p><b>
OTHER DUITIES:</b></p><p>
Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job. Duties, responsibilities and activities may change at any time with or without notice.</p>
Requirements:
<p>
 <b>EDUCATION, CREDENTIALS &amp; EXPERIENCE REQUIREMENTS:</b></p><ul><li>
High School graduate or equivalent.</li><li>
Minimum of three (3) years of relevant experience in a healthcare setting, preferably in medical billing, insurance verification, pre-authorization, and scheduling</li><li>
Strong understanding of medical terminology, ICD-10, and CPT coding (required).</li><li>
Previous experience in appointment scheduling in a health care environment is required (e.g., ? physician office, clinic, or hospital).</li><li>
Familiarity with insurance plans, including HMOs, PPOs, and government programs.</li><li>
Proficient in using computer systems and software, including electronic health records (EHR) and payer portals.</li><li>
Proficient in Microsoft Outlook, Microsoft Word/Excel, computer knowledge to navigate internet websites such as Availity, MyAbility, Relias, Cerner, etc.</li><li>
Possess accurate data entry skills.</li><li>
Excellent communication, interpersonal, and customer service skills.</li><li>
Communicate effectively with patients, physicians, clinical staff, and insurance representatives regarding authorization status and requirements.</li><li>
Follow up on pending authorizations and proactively address any issues or denials.</li><li>
Certified Patient Account Representative (CPAR) and Certified Revenue Cycle Representative (CRCR) preferred but not required.</li><li>
Strong organizational skills and attention to detail.</li><li>
Working knowledge of governmental regulations and other reimbursement criteria preferred.</li><li>
Experience in patient registration, verification and authorization in a medical center or comparable institution demonstrating the skill, knowledge, and ability to perform registration duties preferred.</li><li>
Assisi patients with understanding their insurance coverage and the authorization process.</li></ul></div>

Authorization/Scheduling Coordinator

Ann & Robert H. Lurie Children's Hospital of Chicago

<div><div>Ann &amp; Robert H. Lurie Children&rsquo;s Hospital of Chicago provides superior pediatric care in a setting that offers the latest benefits and innovations in medical technology, research and family-friendly design. As the largest pediatric provider in the region with a 140-year legacy of excellence, kids and their families are at the center of all we do. Ann &amp; Robert H. Lurie Children&rsquo;s Hospital of Chicago is ranked in all 10 specialties by the U.S. News &amp; World Report.</div><div></div><div><div><div><div><div><div><div><div>
Location</div></div></div></div></div></div></div></div>
680 Lake Shore Drive<div></div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div>
Job Description</div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div><div>
This is a remote position that requires mandatory travel to the Lurie Main Hospital campus once per month.</div><div>
Must work 8 hours per day with a flexed start time available.</div><div></div><div>
Must have an Illinois RN license and 3 years of practice experience in Peds, Ambulatory, or Prior Authorization to receive an interview.</div><div>
Experience using EPIC electronic medical record preferred.</div><div></div><div>
General Summary:</div><div>
The Prior Authorization Nurse Coordinator coordinates the activities which pertain to the Prior Authorization Department. The Nurse Coordinator is responsible for ensuring all in-scope medication prior authorizations are completed across the organization as well as facilitating imaging related pre-certifications that have escalated to a peer-to-peer or clinical appeal level. The Nurse Coordinator is responsible for providing the necessary supporting documentation in collaboration with a group of diverse health care providers.</div><div></div><div>
Essential Job Functions:</div><ul><li><div>
Coordinate the activities which pertain to the Clinical Prior Authorization Department.</div></li><li><div>
Obtain medication prior authorizations from insurance entities utilizing Covermymeds in accordance with standard written procedures, guidelines, and state and federal regulations while also, maintaining compliance to medical record confidentiality regulations.</div></li><li><div>
In coordination with the Financial Clearance team, this RN will manage peer to peer escalation cases for pre-certification and appeals for imaging denials.</div></li><li><div>
Manage correspondence with insurance entities, physicians, specialists, and patients as required and ensuring all necessary supporting documentation is provided for approvals.</div></li><li><div>
Manage denials and submit appeals, ensuring all necessary supporting documentation is provided to get them approved from insurance entities.</div></li><li><div>
Create accurate and consistent documentation in patient&rsquo;s records to ensure that prior authorization information is properly updated. Record all prior authorization phone calls, documents and authorization numbers in EPIC utilizing the patient chart and referral module.</div></li><li><div>
Utilize the patient medical record to submit supporting clinical records and/or providing verbal medical necessity validation and support for pending pre-certifications.</div></li><li><div>
Manage physical medical records and utilization management documentation from insurance entities to support approval of pre-certifications.</div></li><li><div>
Self-driven and motivated to work independently for the purpose of utilizing resources to expand knowledge base on drug information and basic pathophysiology.</div></li><li><div>
Acts as a resource to hospital personnel with regard to the care and coordination of medication prior authorizations as well as pre-certifications and troubleshooting pharmacy end issues as it relates to confirming the pharmacy is able to obtain paid claims.</div></li><li><div>
Other job functions as assigned.</div></li></ul><div></div><div>
Knowledge, Skills and Abilities:</div><ul><li><div>
A BSN degree from an accredited school of nursing and current licensure as a registered professional nurse in the State of Illinois required. Master's prepared preferred.</div></li><li><div>
Three years of relevant nursing experience. With a minimum of 1 year of medication prior authorization and/or pre-certification experience preferred.</div></li><li><div>
Experience working in partnership with health care professionals and support staff in an office setting is necessary.</div></li><li><div>
Must demonstrate the ability to problem solve and support teamwork in a multidisciplinary setting in a positive and professional manner. The candidate must demonstrate excellent written and verbal communication skills.</div></li><li><div>
Knowledge of online authorization systems and status review and ability to track in-process authorizations from multiple sources. Computer skills required. Proficient in Microsoft Office applications preferred.</div></li></ul><div></div><div>
Education</div>
Bachelor's Degree: Nursing (Required)<div></div><div>
Pay Range</div>
$83,200.00-$137,280.00 Salary<div></div><div>
At Lurie Children&rsquo;s, we are committed to competitive and fair compensation aligned with market rates and internal equity, reflecting individual contributions, experience, and expertise. The pay range for this job indicates minimum and maximum targets for the position. Ranges are regularly reviewed to stay aligned with market conditions. In addition to base salary, Lurie Children&rsquo;s offer a comprehensive rewards package that may include differentials for some hourly employees, leadership incentives for select roles, health and retirement benefits, and wellbeing programs. For more details on other compensation, consult your recruiter or click the following <div>link</div> to learn more about our benefits.</div><div></div><div>
Benefit Statement</div><div></div><div>
For full time and part time employees who work 20 or more hours per week we offer a generous benefits package that includes:</div><div>
Medical, dental and vision insurance</div><div>
Employer paid group term life and disability</div><div>
Employer contribution toward Health Savings Account</div><div>
Flexible Spending Accounts</div><div>
Paid Time Off (PTO), Paid Holidays and Paid Parental Leave</div><div>
403(b) with a 5% employer match</div><div></div><div>
Various voluntary benefits:</div><ul><li><div>
Supplemental Life, AD&amp;D and Disability</div></li><li><div>
Critical Illness, Accident and Hospital Indemnity coverage</div></li><li><div>
Tuition assistance</div></li><li><div>
Student loan servicing and support</div></li><li><div>
Adoption benefits</div></li><li><div>
Backup Childcare and Eldercare</div></li><li><div>
Employee Assistance Program, and other specialized behavioral health services and resources for employees and family members</div></li><li><div>
Discount on services at Lurie Children&rsquo;s facilities</div></li><li><div>
Discount purchasing program</div></li></ul><div></div><div>
There&rsquo;s a Place for You with Us</div><div></div><div>
At Lurie Children&rsquo;s, we embrace and celebrate building a team with a variety of backgrounds, skills, and viewpoints &mdash; recognizing that different life experiences strengthen our workplace and the care we provide to the Chicago community and beyond. We treat everyone fairly, appreciate differences, and make meaningful connections that foster belonging. This is a place where you can be your best, so we can give our best to the patients and families who trust us with their care.</div><div></div><div><i><br>
Lurie Children&rsquo;s and its affiliates are equal employment opportunity employers. All qualified applicants will receive consideration for employment without regard to race, color, sex, sexual orientation, gender identity or expression, religion, national origin, ancestry, age, disability, marital status, pregnancy, protected veteran status, order of protection status, protected genetic information, or any other characteristic protected by law.</i></div><div>
Support email: <div>peoplequestions@luriechildrens.org</div></div></div>

Prior Authorization Nurse Coordinator

Coastal Communities Physician Network

Under the direction of the Clinic Supervisor, this position is responsible to for verifying and interpreting member benefits for the health plans. The Referral Coordinator will interact with other departments, clinic personnel, and outside providers in a professional and friendly manner, to create and maintain a positive relationship with our internal and external customers.
<br><br>
1.1
<br><br>
1.1 To be efficient in use of UM prior authorization systems utilized.
<br><br>
1.2 Verify eligibility and benefit interpretation, via health plan and Medicare (CMS) websites.
<br><br>
1.3 Be a resource for providers in regard to questions regarding network specialists.
<br><br>
1.4 Ability to prepare authorizations and refer to appropriate providers/facilities and durable medical equipment (DME) companies.
<br><br>
1.5 Guide and communicate with physician office, processing staff and other departments as needed to ensure collaboration and open discussion regarding all aspects of the referral process. Including responding to messages within the next business day.
<br><br>
1.6 Review accuracy of pending referrals for ICD-10, CPT, HCPC code and provider selections made by the Authorization Clerk staff.
<br><br>
1.7 Ensure referral data entry was accurately inputted into UM systems based on the referral and clinical information submitted.
<br><br>
1.8 Have a complete understanding of established policy and procedure within Heritage provider network regarding the authorization processes.
<br><br>
1.9 Maintaining assigned duties in an acceptable manner.
<br><br>
1.10 Inform management on a daily basis when problems arise or when work falls behind.
<br><br>
1.11Compile and document good faith attempts in obtaining medical records for each pending referral when there is lack of information.
<br><br>
1.12 Compile clinical based guidelines, criteria and/or benefit information prior to forwarding referral to UM Managers for clinical review.
<br><br>
1.13 Maintain filing in a timely manner.
<br><br>
1.14 Provide Referral Coordinator coverage as needed.
<br><br>
1.15 Process referral published on daily trending reports to maintain compliance with health plans and CMS timeframe regulations.
<br><br>
1.16 Follow and have a complete understanding of the health plan and CMS regulations regarding timelines standards, benefit, and guideline hierarchy.
<br><br>
1.17 Adaptable to regulation and necessary departmental procedure changes that affect UM prior authorization processes.
<br><br>
1.18 Compliance with HIPM regulations and maintain patient confidentiality.
<br><br>
1.19 Cultural and Linguistics training required annually.
<br><br>
1.20 Other duties as assigned.
<br><br>
<b>Requirements:</b><br>
8.1 High School graduate or GED certification required.
<br><br>
8.2 One-year minimum experience working in a medical office environment (IPA or HMO preferred) with prior authorizations required.
<br><br>
8.3 Knowledge of medical terminology required.
<br><br>
8.4 Knowledge of HCPC, CPT and ICD-10, required.
<br><br>
8.5 Proficient written and oral communication skills.
<br><br>
8.6 Demonstrate proficiency in computer systems utilized.
<br><br>
8.7 Ability to remain organized and able to manage competing priorities.
<br><br>
8.8 Demonstrate good judgement.
<br><br>
8.9 Demonstrate ability to take and follow through with delegated tasks and accountability.
<br><br>
8.10Demonstrate resourcefulness in problem-solving.
<br><br>
The pay range for this position at commencement of employment is expected to be reasonably between $24.27 and $28.55. However, base pay offered may vary depending on multiple individualized factors, including market location, job-related knowledge, skills, and experience.
<br><br>
If hired, employee will be in an “at-will position” and the Company reserves the right to modify base salary (as well as any other discretionary payment or compensation program) at any time, including for reasons related to individual performance, Company or individual department/team performance, and market factors.
<br><br>
<b>Compensation:</b> Between $24.27 and $28.55

Referral Coordinator

Blanchard Valley Health System

<div><p><b>PURPOSE OF THIS POSITION</b></p><p>
The primary purpose of this position is to plan and coordinate the authorization functions for BVHS patients. Act as a liaison between the physicians, facilities, patients and professional billing companies. Coordinates information between patients, their insurance companies, and the facilities at which the patient is being served. Responsible for accurately entering patient data and interpreting insurance verification and coverage for patients.</p><p><b>
JOB DUTIES/RESPONSIBILITIES</b></p><ul>
<li>
Duty 1: Ability to process patient authorizations in a timely manner with accurate data.</li>
<li>Duty 2: Ability to use current EHR system and all insurance verification and authorization tools, identifies and confirms active insurance coverage and required authorizations for outpatient and inpatient services. Ability to discover/provide clinical data in the EHR or from the ordering provider to support authorization needs.</li>
<li>Duty 3: Ability to effectively communicate with insurance and governmental agencies in order to have complete and accurate procedure authorizations and approvals.</li>
<li>Duty 4: Ability to professionally communicate to all patients and office staff, and meet age specific requirements for handling their requests.</li>
<li>Duty 5: Continue to stay informed of any statute and/or regulation that could affect Authorization requirements.</li>
<li>Duty 6: Work through the retro auth request lists, working with denials, and have the ability to timely address order/rad changes that may affect an authorization.</li>
<li>Duty 7: Acts as a liaison between the facility, patient/family and ordering provider to resolve problems and/or address complaints.</li>
<li>Duty 8: Participates in a variety of unit and hospital educational programs to maintain current skills and competency levels. Participates in and fully supports new hire and other department training and shadowing. Provides a positive learning environment and compassionate mentoring.</li>
<li>Duty 9: Has ability to problem solve and offers assistance as needed to all customer groups.</li>
<li>Duty 10: Performs all duties and responsibilities in a manner consistent with and supportive of the mission and value statement of Blanchard Valley Health System.</li>
</ul><p><b>
REQUIRED QUALIFICATIONS</b></p><ul>
<li>
High school graduate or GED equivalent</li>
<li>Data entry and/or PC experience required</li>
<li>Medical terminology coursework or knowledge required</li>
<li>BWC, VA, Medicare, Medicaid and commercial healthcare insurance knowledge</li>
<li>Positive service-oriented interpersonal and communication skills required</li>
<li>Individual must be able to demonstrate the knowledge and skills necessary to provide care appropriate to the age of the patient served on his/her assigned unit/department. The individual must demonstrate knowledge of the principles of growth and development over the life span and possess the ability to assess data reflective of the patient status. Must be able to interpret the appropriate information needed to identify each patient&rsquo;s requirements relative to their age-specific needs and to provide the care needed as described in the area&rsquo;s policies and procedures.</li>
</ul><p><b>
PREFERRED QUALIFICATIONS</b></p><ul>
<li>
Some related college preferred</li>
<li>Insurance verification and authorization submission/verification experience preferred</li>
<li>Knowledge of current EHR and insurance verification/authorization software</li>
<li>Ability to meet remote work requirements.</li>
</ul><p><b>
PHYSICAL DEMANDS</b></p><p>
This position requires a full range of body motion with intermittent walking, lifting, bending, climbing, squatting, kneeling, twisting, sitting and standing. The associate must be able to lift 20-30 pounds or more. The individual must have excellent eye-hand coordination with the ability to grasp, push and pull, have fine fingers dexterity and manipulation. The associate must be able to reach work above the shoulders. This position requires corrected vision and hearing in the normal range. The associate must have excellent verbal skills to communicate with patients, physicians, and co-workers.</p><p><b>
This position is classified &ldquo;at risk&rdquo; for possible occupational exposure to blood borne pathogens (HBV, HIV, etc.)</b></p></div>
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</div><div></div><div><h3 class="jobSectionHeader"><b>Job Snapshot</b></h3>
<div><h4 class="jobSectionHeader"><b>Employee Type</b></h4>
Per Diem
</div><div><h4 class="jobSectionHeader"><b>Street Address</b></h4>
1900 South Main Street
</div><div><h4 class="jobSectionHeader"><b>Location Map</b></h4>
</div><div><h4 class="jobSectionHeader"><b>Date Posted</b></h4>
03/10/2026
</div><div><h4 class="jobSectionHeader"><b>Job ID</b></h4>
19726
</div><div><h4 class="jobSectionHeader"><b>Shift</b></h4>
1st</div></div></div>

Patient Access Authorization Specialist (PRN)

Elevance Health

<div><p><b>Job ID:</b><b>JP00046432</b></p><p></p><p><b>
Anticipated Start Date: 05/13/2026</b></p><p>
Please note this is the target date and is subject to change. BCForward will send official notice ahead of a confirmed start date.</p><p></p><p><b>
Elevance Health</b> is a health company dedicated to improving lives and communities &ndash; and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve.</p><p></p><p>
Responsible for coordinating cases for precertification and prior authorization review.</p><p></p><p><b>
Primary duties may include, but are not limited to:</b></p><ul><li><p>
Managing incoming calls or incoming post services claims work.
</p></li><li><p>Determines contract and benefit eligibility; provides authorization for inpatient admission, outpatient precertification, prior authorization, and post service requests.</p></li><li><p>
Refers cases requiring clinical review to a Nurse reviewer.
</p></li><li><p>Responsible for the identification and data entry of referral requests into the UM system in accordance with the plan certificate.</p></li><li><p>
Responds to telephone and written inquiries from clients, providers and in-house departments.
</p></li><li><p>Conducts clinical screening process.
</p></li><li><p>Authorizes initial set of sessions to provider.
</p></li><li><p>Checks benefits for facility based treatment.
</p></li><li><p>Develops and maintains positive customer relations and coordinates with various functions within the company to ensure customer requests and questions are handled appropriately and in a timely manner.</p></li></ul><p></p><p><b>
Requirements</b>:</p><ul><li><p>
Requires HS diploma or GED and a minimum of 1 year of customer service or call-center experience; or any combination of education and experience which would provide an equivalent background.
</p></li><li><p>Associates will need to review service details and enter the authorization in our system and electronically send a confirmation letter to the provider. Associates will need to review our fax queues and pend a line in our UM system.</p></li><li><p>
Medical terminology training and experience in medical or insurance field preferred.
</p></li><li><p>Associates in this role are expected to have strong oral, written and interpersonal communication skills, problem-solving skills, facilitation skills, and analytical skills.</p></li></ul><p></p><p><b>
Job Type:</b><b> </b>Contract Opportunity only</p><p></p><p><b>
Additional Details:</b></p><ul><li><p>
100% remote.
</p></li><li><p>Monday - Friday 8 AM-5 PM EST. - NO OVERTIME / NO WEEKEND</p></li></ul><p></p><p>
Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, contractors are required to work at an Elevance Health location at least once per week, and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process. Candidates must reside within 50 miles or 1-hour commute each way of a relevant Elevance Health location.</p><p></p><p><b>
About BCForward:</b></p><p>
Founded in 1998 on the idea that industry leaders needed a professional service, and workforce management expert, to fuel the development and execution of core business and technology strategies, BCforward is a Black-owned firm providing unique solutions supporting value capture and digital product delivery needs for organizations around the world. Headquartered in Indianapolis, IN with an Offshore Development Center in Hyderabad, India, BCforward's 6,000 consultants support more than 225 clients globally.</p><p></p><p>
BCforward champions the power of human potential to help companies transform, accelerate, and scale. Guided by our core values of People-Centric, Optimism, Excellence, Diversity, and Accountability, our professionals have helped our clients achieve their strategic goals for more than 25 years. Our strong culture and clear values have enabled BCforward to become a market leader and best in class place to work.</p><p></p><p><b>
BCForward </b>is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, or protected veteran status and will not be discriminated against based on disability.</p><p></p><p>
To learn more about how BCforward collects and uses personal information as part of the recruiting process, view our Privacy Notice and CCPA Addendum. As part of the recruitment process, we may ask for you to disclose and provide us with various categories of personal information, including identifiers, professional information, commercial information, education information, and other related information. BCforward will only use this information to complete the recruitment process.</p><p></p><p>
This posting is not an offer of employment. All applicants applying for positions in the United States must be legally authorized to work in the United States. The submission of intentionally false or fraudulent information in response to this posting may render the applicant ineligible for the position. Any subsequent offer of employment will be considered employment at-will regardless of the anticipated assignment duration. employed</p>
<div><p><b>Benefits Information</b></p>
<p></p><p>BCForward offers all eligible employees a comprehensive benefits package including, but not limited to major medical, HSA, dental, vision, employer-provided group life, voluntary life insurance, short-term disability, long-term disability, and 401k.</p><p></p><p>
The company is fully committed to ensuring equal pay opportunities for equal work regardless of gender, race, or any other category protected by federal, state, and local pay equity laws<i>. </i>This does not encompass additional non-standard compensation (e.g., benefits, paid time off, per diem, etc.).</p></div></div><p></p>

Utilization Management Rep I (contract)

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