medical authorization specialist

CareMed Specialty Pharmacy

<div>
 <strong>
  Pharmacy Prior Authorization Specialist &ndash; CareMed Specialty Pharmacy
  <br/>
  <br/>
 </strong>
 <em>
  Houston, TX
 </em>
 |
 <em>
  Full-Time
 </em>
 |
 <em>
  Starting at $23.00/hr and up
  <br/>
  <br/>
 </em>
 <strong>
  Sign-On Bonus:
 </strong>
 $5,000 for employees starting before July 31, 2026.
 <br/>
 <br/>
 <strong>
  Join a mission-driven team making a difference in the lives of cancer patients.
  <br/>
  <br/>
 </strong>
 CareMed Specialty Pharmacy is seeking a
 <strong>
  Pharmacy Prior Authorization Specialist
 </strong>
 to join our dedicated team in Houston, TX. This is a full-time position ideal for candidates local to the area.
 <strong>
  Remote work possible after initial on-site training.
  <br/>
  <br/>
 </strong>
 <strong>
  Company Benefits
  <br/>
  <br/>
 </strong>
 <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
   <br/>
   <br/>
  </li>
 </ul>
 <strong>
  Why Join Us?
  <br/>
  <br/>
 </strong>
 <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.
   <br/>
   <br/>
  </li>
 </ul>
 <strong>
  What You&rsquo;ll Do
  <br/>
  <br/>
 </strong>
 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.
 <br/>
 <br/>
 <strong>
  How You&rsquo;ll Do This
  <br/>
  <br/>
 </strong>
 <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.
   <br/>
   <br/>
  </li>
 </ul>
 <strong>
  Required
  <br/>
  <br/>
 </strong>
 <strong>
  What You Bring
  <br/>
  <br/>
 </strong>
 <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
   <br/>
   <br/>
  </li>
 </ul>
 <strong>
  Preferred
  <br/>
  <br/>
 </strong>
 <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
   <br/>
   <br/>
  </li>
 </ul>
 <strong>
  Ready to make a meaningful impact? Apply today and help us better the lives of those battling cancer.
  <br/>
  <br/>
 </strong>
 <strong>
  Company Values: Teamwork, Respect, Integrity, Passion
 </strong>
</div>


Prior Authorization Specialist

<div><div><div><b>Pharmacy Prior Authorization Specialist &ndash; CareMed Specialty Pharmacy</b><br>
<i>Waltham, MA</i> | <i>Full-Time</i> | <i>Starting at $23.00/hr and up</i></div>
<div></div><div><b>Sign-On Bonus: </b>$5,000 for employees starting before July 31, 2026.</div>
<div></div><div><b>Join a mission-driven team making a difference in the lives of cancer and rare disease patients.</b></div>
<div></div><div>CareMed Specialty Pharmacy is seeking a <b>Pharmacy Prior Authorization Specialist</b> 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><b>Company Benefits</b></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> <p></p><div><b>Why Join Us?</b></div>
<ul><li>A career with purpose: Help patients access life-saving medications.</li>
<li>Supportive culture: We value <b>teamwork, respect, integrity, and passion</b>.</li>
<li>Growth opportunities: We invest in your professional and personal development.</li>
</ul><p></p><div><b>What You&rsquo;ll Do</b></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><b>How You&rsquo;ll Do This</b></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> <p></p><div><b>What You Bring</b></div>
<div><b>Required:</b></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><b>Preferred:</b></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><p></p><div><b>Ready to make a meaningful impact? Apply today and help us better the lives of those battling cancer.</b></div></div></div>

Riverview Health

<div>
 <strong>
  Job Summary
  <br/>
  <br/>
 </strong>
 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.
 <br/>
 <br/>
 <strong>
  Job Responsibilities
  <br/>
  <br/>
 </strong>
 <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.
   <br/>
   <br/>
  </li>
 </ul>
 <strong>
  Education Requirements
  <br/>
  <br/>
 </strong>
 <ul>
  <li>
   Minimum: Associate degree in healthcare or business administration and/or related coursework, or comparable experience
  </li>
  <li>
   Preferred: Experience in Epic
   <br/>
   <br/>
  </li>
 </ul>
 <strong>
  Experience Requirements
  <br/>
  <br/>
 </strong>
 <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
   <br/>
   <br/>
  </li>
 </ul>
 <strong>
  License/Certification Requirements
  <br/>
  <br/>
 </strong>
 <ul>
  <li>
   None
   <br/>
   <br/>
  </li>
 </ul>
 Education
 <br/>
 <br/>
 <strong>
  Required
  <br/>
  <br/>
 </strong>
 <ul>
  <li>
   Associates or better in Other
   <br/>
   <br/>
  </li>
 </ul>
 Equal Opportunity Employer
 <br/>
 <br/>
 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

Blue Cross Blue Shield of Arizona

<div>
 Awarded a Healthiest Employer, Blue Cross Blue Shield of Arizona aims to fulfill its mission to inspire health and make it easy. AZ Blue offers a variety of health insurance products and services to meet the diverse needs of individuals, families, and small and large businesses as well as providing information and tools to help individuals make better health decisions.
 <br/>
 <br/>
 At AZ Blue, we have a hybrid workforce strategy, called Workability, that offers flexibility with how and where employees work. Our positions are classified as hybrid, onsite or remote. While the majority of our employees are hybrid, the following classifications drive our current minimum onsite requirements:
 <br/>
 <br/>
 <ul>
  <li>
   Hybrid People Leaders: must reside in AZ, required to be onsite at least twice per week
  </li>
  <li>
   Hybrid Individual Contributors: must reside in AZ, unless otherwise cited within this posting, required to be onsite at least once per week
  </li>
  <li>
   Hybrid 2 (Operational Roles such as but not limited to: Customer Service, Claims Processors, and Correspondence positions): must reside in AZ, unless otherwise cited within this posting, required to be onsite at least once per month
  </li>
  <li>
   Onsite: daily onsite requirement based on the essential functions of the job
  </li>
  <li>
   Remote: not held to onsite requirements, however, leadership can request presence onsite for business reasons including but not limited to staff meetings, one-on-ones, training, and team building
   <br/>
   <br/>
  </li>
 </ul>
 Please note that onsite requirements may change in the future, based on business need, and job responsibilities. Most employees should expect onsite requirements and at a minimum of once per week.
 <br/>
 <br/>
 <strong>
  This remote work opportunity requires residency, and work to be performed, within the State of Arizona.
  <br/>
  <br/>
 </strong>
 <strong>
  PURPOSE OF THE JOB
  <br/>
  <br/>
 </strong>
 Ensures accuracy and timeliness in the completion of prior authorization (PA) requests to meet contractual requirements and ensures all reviews utilize nationally recognized and evidence-based standards for the Medicaid Segment which includes Medicaid and Medicare Advantage / Dual Eligible Special Needs Plan (D-SNP), and Affordable Care Act (ACA) members. Ensures the completion, accuracy, and timeliness in the Notice of Action (NOA) process.
 <br/>
 <br/>
 <strong>
  Qualifications
  <br/>
  <br/>
 </strong>
 <strong>
  REQUIRED QUALIFICATIONS
  <br/>
  <br/>
 </strong>
 <strong>
  Required Work Experience
  <br/>
  <br/>
 </strong>
 <ul>
  <li>
   3 years of clinical experience
  </li>
  <li>
   1 year of Medicaid/Medicare experience
  </li>
  <li>
   1 year prior authorization and member and provider notification (NOA) experience
  </li>
  <li>
   1 year experience with National Committee for Quality Assurance (NCQA) standards
   <br/>
   <br/>
  </li>
 </ul>
 <strong>
  Required Education
  <br/>
  <br/>
 </strong>
 <ul>
  <li>
   Associate degree in Nursing
   <br/>
   <br/>
  </li>
 </ul>
 <strong>
  Required Licenses
  <br/>
  <br/>
 </strong>
 <ul>
  <li>
   Active, current, and unrestricted license to practice in the State of Arizona (a state in the United States) as a health professional, including RN or LPN.
   <br/>
   <br/>
  </li>
 </ul>
 <strong>
  Required Certifications
  <br/>
  <br/>
 </strong>
 <ul>
  <li>
   N/A
   <br/>
   <br/>
  </li>
 </ul>
 <strong>
  Preferred Qualifications
  <br/>
  <br/>
 </strong>
 <strong>
  Preferred Work Experience
  <br/>
  <br/>
 </strong>
 <ul>
  <li>
   3+ years of experience in managed care
  </li>
  <li>
   3+years of experience in prior authorization/utilization review
   <br/>
   <br/>
  </li>
 </ul>
 <strong>
  Preferred Education
  <br/>
  <br/>
 </strong>
 <ul>
  <li>
   Bachelor of Science in Nursing
   <br/>
   <br/>
  </li>
 </ul>
 <strong>
  Preferred Licenses
  <br/>
  <br/>
 </strong>
 <ul>
  <li>
   N/A
   <br/>
   <br/>
  </li>
 </ul>
 <strong>
  Preferred Certifications
  <br/>
  <br/>
 </strong>
 <ul>
  <li>
   N/A
   <br/>
   <br/>
  </li>
 </ul>
 <strong>
  Essential Job Functions And Responsibilities
  <br/>
  <br/>
 </strong>
 <strong>
  ALL LEVELS
  <br/>
  <br/>
 </strong>
 <ul>
  <li>
   Ensures the accuracy and timeliness of prior authorization requests to meet contractual requirements.
  </li>
  <li>
   Coordinates and manages the established preauthorization review process for pre-service requests.
  </li>
  <li>
   Ensures the use of nationally recognized and evidence-based standards in the completion of all pre-service reviews.
  </li>
  <li>
   Utilize clinical skills, chart review, physician communication and appropriate criteria for approval of pre-service requests; escalate pre-service request(s) to the medical director for determination when criteria not met.
  </li>
  <li>
   Clearly define and document review rationale to support approval, Medical Director Review and/or Notice of Action document.
  </li>
  <li>
   Initiates interdepartmental coordination to ensure quality and timely care for members.
  </li>
  <li>
   Participates in Quality Improvement Projects as directed.
  </li>
  <li>
   Participate in department audits and other regulatory activities.
  </li>
  <li>
   Engage cross-functionally and participate in special projects as needed.
  </li>
  <li>
   Performs Notice of Action (NOA) process.
  </li>
  <li>
   Participate in annual policy and procedure review and revision.
  </li>
  <li>
   Perform all other duties as assigned.
  </li>
  <li>
   The position requires a full-time work schedule,40 hours per week, plus any additional hours as requested or as needed to meet business requirements.
   <br/>
   <br/>
  </li>
 </ul>
 <strong>
  COMPETENCIES
  <br/>
  <br/>
 </strong>
 <strong>
  Required Competencies
  <br/>
  <br/>
 </strong>
 <strong>
  Required Job Skills
  <br/>
  <br/>
 </strong>
 <ul>
  <li>
   Computer skills to include Microsoft Office applications, Word, Excel, and Outlook
  </li>
  <li>
   Ability to use electronic medical management systems
  </li>
  <li>
   Analytical problem solving skills
   <br/>
   <br/>
  </li>
 </ul>
 <strong>
  Required Professional Competencies
  <br/>
  <br/>
 </strong>
 <ul>
  <li>
   N/A
   <br/>
   <br/>
  </li>
 </ul>
 <strong>
  Required Leadership Experience And Competencies
  <br/>
  <br/>
 </strong>
 <ul>
  <li>
   N/A
   <br/>
   <br/>
  </li>
 </ul>
 <strong>
  Preferred Competencies
  <br/>
  <br/>
 </strong>
 <strong>
  Preferred Job Skills
  <br/>
  <br/>
 </strong>
 N/A
 <br/>
 <br/>
 <strong>
  Preferred Professional Competencies
  <br/>
  <br/>
 </strong>
 N/A
 <br/>
 <br/>
 <strong>
  Preferred Leadership Experience And Competencies
  <br/>
  <br/>
 </strong>
 N/A
 <br/>
 <br/>
 <strong>
  Our Commitment
  <br/>
  <br/>
 </strong>
 AZ Blue does not discriminate in hiring or employment on the basis of race, ethnicity, color, religion, sex, sexual orientation, gender identity, national origin, age, disability, protected veteran status or any other protected group.
 <br/>
 <br/>
 Thank you for your interest in Blue Cross Blue Shield of Arizona. For more information on our company, see azblue.com. If interested in this position, please apply.
</div>


Prior Authorization Nurse - Remote - AZ

Corazon Imaging

<p><b>Full-Time | Hybrid: 3 Days In-Office / 2 Days Remote</b></p><p><b>About Corazon Imaging</b></p><p>Corazon Imaging is the leading outpatient provider of coronary CT angiography, or CCTA, in the United States. Corazon is focused on expanding access to advanced, non-invasive cardiac imaging that helps physicians identify coronary artery disease earlier, improve patient care, and support better clinical decision-making.</p><p>As Corazon continues to grow nationally, we are seeking a highly organized, detail-oriented <b>Cardiac CT Reporting Operations Specialist</b> to support the timely completion, quality control, combination, and distribution of cardiac CT imaging reports.</p><p><b>General Summary</b></p><p>The Cardiac CT Reporting Operations Specialist will manage the operational workflow for CCTA reporting, including tracking report turnaround times, coordinating the completion and combination of CCTA, FFR-CT, AI-plaque analysis, and extracardiac overread reports, and ensuring final reports are accurately distributed to ordering providers and appropriate recipients.</p><p>This role will also support the creation and submission of templated letters of medical necessity, respond to medical records requests, and help ensure that Corazon&rsquo;s reporting operations are timely, complete, compliant, and provider-focused.</p><p>This is an ideal role for someone with a background in radiology operations, cardiology practice operations, medical records, health information management, prior authorization, imaging center administration, or clinical documentation support.</p><p><b>Essential Duties: </b></p><p><b>CCTA Reporting Workflow Management</b></p><ul><li>Monitor all CCTA cases from image acquisition through final report completion and distribution.</li><li>Track report turnaround time and identify cases at risk of delay.</li><li>Communicate with physicians, radiologists, reading teams, and internal operations staff to ensure reports are completed within expected timeframes.</li><li>Maintain daily reporting worklists and case-status trackers.</li><li>Escalate delayed, incomplete, or missing reports to appropriate leadership.</li><li>Support Corazon&rsquo;s commitment to timely, accurate, and complete cardiac CT reporting.</li><li>Perform other duties as assigned.</li></ul><p><b>Report Combination and Finalization</b></p><ul><li>Coordinate and combine multiple report components into a complete final reporting package, including:</li><li>CCTA report</li><li>FFR-CT report, when applicable</li><li>AI-plaque analysis report, when applicable</li><li>Extracardiac overread report</li><li>Ensure all applicable report components are present before final distribution.</li><li>Review reports for completeness, formatting consistency, correct patient identifiers, correct ordering provider information, and appropriate attachment of supporting documentation.</li><li>Confirm that revised or addended reports are properly tracked and redistributed when necessary.</li></ul><p><b>Report Distribution</b></p><ul><li>Distribute finalized reports to ordering physicians, referring practices, and other approved recipients through approved channels.</li><li>Ensure reports are submitted to the correct practice, provider, fax number, portal, or electronic medical record destination.</li><li>Maintain accurate documentation of report delivery and confirmation when required.</li><li>Assist with provider office follow-up when reports are missing, delayed, or need to be resent.</li><li>Support excellent communication with referring provider offices.</li></ul><p><b>Letters of Medical Necessity and Documentation Support</b></p><ul><li>Prepare templated letters of medical necessity using approved Corazon templates.</li><li>Ensure letters are completed accurately using case-specific information, payer requirements, and supporting clinical documentation.</li><li>Coordinate with internal teams to obtain missing information needed for letters or appeals.</li><li>Maintain organized records of submitted letters and related documentation.</li><li>Support prior authorization, appeal, and medical necessity workflows as needed.</li></ul><p><b>Medical Records Requests</b></p><ul><li>Processing medical records requests in accordance with company policy and HIPAA requirements.</li><li>Verify requestor authorization and ensure records are released only to appropriate parties.</li><li>Gather and send requested imaging reports, supporting documentation, and related records.</li><li>Track completion of medical records requests and maintain proper documentation.</li><li>Work with internal teams to resolve incomplete, unclear, or urgent records requests.</li></ul><p><b>Quality Control and Compliance</b></p><ul><li>Ensure all reporting and records workflows are completed in a HIPAA-compliant manner.</li><li>Protect patient confidentiality and sensitive health information at all times.</li><li>Identify workflow gaps, recurring delays, or documentation issues and escalate appropriately.</li><li>Help maintain standard operating procedures for report tracking, report distribution, letters of medical necessity, and medical records requests.</li><li>Participate in process improvement initiatives to improve turnaround time, reporting accuracy, and provider satisfaction.</li></ul><p><b>Required Qualifications</b></p><ul><li>Minimum of 2&ndash;4 years of experience in a healthcare administrative, radiology, cardiology, medical records, prior authorization, or clinical documentation role.</li><li>Strong understanding of HIPAA and patient privacy requirements.</li><li>Experience working with medical records, physician reports, clinical documentation, or imaging reports.</li><li>Strong attention to detail and ability to manage multiple time-sensitive cases at once.</li><li>Excellent written and verbal communication skills.</li><li>Comfortable communicating with physicians, radiologists, provider offices, patients, and internal team members.</li><li>Strong organizational skills and ability to maintain accurate tracking systems.</li><li>Proficiency with Microsoft Office, Google Workspace, EMR systems, fax platforms, portals, or similar healthcare workflow tools.</li><li>Ability to work independently in a hybrid environment while remaining accountable to daily deadlines.</li></ul><p><b>Preferred Qualifications</b></p><ul><li>Experience in radiology, cardiology, outpatient imaging, hospital imaging, or diagnostic testing operations.</li><li>Familiarity with coronary CTA, cardiac imaging, CT imaging, or advanced imaging workflows.</li><li>Experience with PACS, RIS, EMR, medical records platforms, or provider portal systems.</li><li>Prior experience preparing or supporting letters of medical necessity, prior authorization documentation, or payer appeals.</li><li>Associate&rsquo;s or bachelor&rsquo;s degree in healthcare administration, health information management, business, or a related field preferred.</li><li>RHIT, RHIA, CPC, CMA, medical assistant, LPN, radiology assistant, or similar healthcare credential helpful but not required.</li></ul><p><b>Ideal Candidate Background</b></p><p>The ideal candidate does not need to be a clinician, but should have meaningful experience in a healthcare environment where accuracy, timeliness, documentation, and patient confidentiality are critical.</p><p>Strong candidates may come from backgrounds such as:</p><ul><li>Radiology reporting coordinator</li><li>Imaging center operations coordinator</li><li>Cardiology practice coordinator</li><li>Medical records specialist</li><li>Health information management specialist</li><li>Prior authorization or appeals specialist</li><li>Clinical documentation coordinator</li><li>Physician practice operations specialist</li><li>Medical assistant with strong administrative and documentation experience</li><li>PACS/RIS or imaging workflow support specialist</li></ul><p>This role is best suited for someone who is highly reliable, detail-driven, comfortable with medical terminology, and able to manage multiple moving parts in a fast-paced clinical operations environment.</p><p><b>Schedule and Work Environment</b></p><ul><li>Full-time position.</li><li>Hybrid schedule: three days per week in office and two days per week remote.</li><li>Standard business hours, with occasional flexibility required based on reporting volume or urgent provider needs.</li><li>Office-based collaboration with clinical operations, reporting, provider relations, billing, authorization, and medical leadership teams.</li></ul><p><b>Compensation and Benefits</b></p><ul><li>Annual salary range: $55,000&ndash;$65,000, based on experience and qualifications.</li><li>Health insurance.</li><li>Paid time off.</li><li>401(k) with company match.</li><li>Additional benefits available based on company policy.</li></ul><p><b>Why Join Corazon Imaging</b></p><p>Corazon Imaging is at the forefront of outpatient coronary CTA and advanced cardiac imaging. This role offers the opportunity to be part of a growing national organization that is improving access to high-quality cardiac imaging and supporting physicians in the early detection of coronary artery disease.</p><p>The Cardiac CT Reporting Operations Specialist will play a key role in ensuring that providers receive accurate, complete, and timely reports that directly support patient care.</p><p>Pay: $55,000.00 - $65,000.00 per year</p><p>Benefits:</p><ul><li>401(k) matching</li><li>Dental insurance</li><li>Flexible schedule</li><li>Health insurance</li><li>Paid time off</li></ul><p>Work Location: Hybrid remote in Southfield, MI 48076</p>

Cardiac CT Reporting Operations Specialist

Dana-Farber Cancer Institute

<div><div><div><div>Job Ref:</div><div>
JR-5367</div></div><br>
<div><div>Location:</div><div>
450 Brookline Ave, BOSTON, MA 02215</div><br>
</div>
<div><div>Category:</div><div>
Finance/Accounting</div></div><br>
<div><div>Employment Type:</div><div>
Full time</div></div><br>
<div><div>Work Location:</div><div>
Remote: occasional onsite</div></div><br>
<div></div><div><div>Salary/Pay Rate:</div><div>
$49,700.00 - $59,500.00 per year</div>
</div></div><p><b>Overview</b></p>
<p></p><div><div>The Financial Clearance Specialist serves as a patient liaison for pre-service financial clearance at Dana-Farber Cancer Institute (DFCI) and engagement throughout the patient&rsquo;s financial experience. Reporting to, and under close direction of, the Access &amp; Financial Engagement Supervisor, the Financial Clearance Specialist is responsible for managing all work related to financial clearance of new or prospective patients at DFCI and ongoing authorization for patients with out-of-network/high risk insurance plans. Working in a fast-paced, high-volume, dynamic environment, the Financial Clearance Specialist will demonstrate a strong understanding of payer coverage policies while ing appropriate payer guidelines to all aspects of out-of-network financial clearance. With guidance, the Financial Clearance Specialist will create accurate authorization requests and thorough and concise documentation, monitor requests for decision and communicate to the appropriate stakeholders, including the patient. This role requires attention to detail, the ability to multitask and think strategically, as well as a commitment to service excellence with the goal of protecting the financial interests of both patients and the Institute.<p>
Located in Boston and the surrounding communities, Dana-Farber Cancer Institute is a leader in life changing breakthroughs in cancer research and patient care. We are united in our mission of conquering cancer, HIV/AIDS, and related diseases. We strive to create an inclusive, diverse, and equitable environment where we provide compassionate and comprehensive care to patients of all backgrounds, and design programs to promote public health particularly among high-risk and underserved populations. We conduct groundbreaking research that advances treatment, we educate tomorrow's physician/researchers, and we work with amazing partners, including other Harvard Medical School-affiliated hospitals.</p><p><b><br>
PRIMARY DUTIES AND RESPONSIBILITIES:</b></p><p>
With supervision, the Financial Clearance Specialist I:</p><ul><li>
Reviews and monitors new patient daily appointment record and identifies and prioritizes patients with insurance plans that require prior authorization.</li><li>
Verifies insurance benefits, utilizing automated eligibility systems, payer portals, and/or telephone communication.</li><li>
Accurately and courteously communicates financial clearance process to patients, including a high-level benefits explanation, network status of DFCI for their plan, and authorization/ referral requirements; assists patients with resolving insurance related issues prior to initiating treatment.</li><li>
Reprioritizes work to respond to requests for clearance for clinically urgent patients and produces high quality work under time constraints.</li><li>
Monitors established patient work queues to ensure required authorization and/or referrals are obtained prior to service being rendered and within payer guidelines.</li><li>
Works with patient and/or Primary Care Physicians to complete payer-specific prior authorization request forms and applies appropriate guidelines to prior authorization requests.</li><li>
Responds to health plan-reviewed prior authorization requests that do not meet initial policy criteria. Works with the health plan to resolve issues and/or coordinate appropriate provider-to-health plan interventions (e.g., peer-to-peer discussions, letters of medical necessity, provider-initiated appeals, etc.).</li><li>
Effectively communicates with appropriate DFCI staff (e.g., New Patient Representatives, New Patient Coordinators, Established Patient Schedulers, clinical team) regarding financial clearance status.</li><li>
Maintains accurate, thorough, and complete records related to financial clearance activities to support post-claim denial workflows.</li><li>
Completes assigned work queues, projects, and other duties as directed.</li><li><p><br>
</p><p><b>KNOWLEDGE, SKILLS, AND ABILITIES REQUIRED:</b></p></li><li>
Strong customer service and communication skills, both written and verbal.</li><li>
Strong relationship building skills and collaboration abilities.</li><li>
Solid analytical and problem-solving skills.</li><li>
Ability to prioritize work with direction within established policies and meet pre-determined deadlines in a fast-paced environment.</li><li><b>
Ability to work with sensitive patient information and maintain confidentiality; ability to use good judgment, tact, and sensitivity.</b></li><li>
Working knowledge of Epic or other hospital information systems.</li><li>
Demonstrated knowledge of third-party payer rules and regulations.</li><li>
Proficiency in Microsoft Office preferred</li></ul><ul><li><b>
MINIMUM JOB QUALIFICATIONS:</b><br>
Minimum Education:<br>
High school diploma or GED, Bachelor&rsquo;s Degree preferred<br>
<br>
Minimum Experience:</li><li>
2-3 years of relevant work experience, such as hospital/physician office, prior authorization, financial counseling and/or billing experience.
</li><li>Other relevant experiences include, but are not limited to healthcare/business administration, training or instructional design, health insurance, medical policy review, and/or pharmacy support.</li></ul><p>
At Dana-Farber Cancer Institute, we work every day to create an innovative, caring, and inclusive environment where every patient, family, and staff member feels they belong. As relentless as we are in our mission to reduce the burden of cancer for all, we are committed to having faculty and staff who offer multifaceted experiences. Cancer knows no boundaries and when it comes to hiring the most dedicated and compassionate professionals, neither do we. If working in this kind of organization inspires you, we encourage you to .</p><p>
Dana-Farber Cancer Institute is an equal opportunity employer and affirms the right of every qualified applicant to receive consideration for employment without regard to race, color, religion, sex, gender identity or expression, national origin, sexual orientation, genetic information, disability, age, ancestry, military service, protected veteran status, or other characteristics protected by law.
</p><h3 class="jobSectionHeader"><b>EEO Poster</b></h3>
.<p>
Pay Transparency Statement</p><p>
The hiring range is based on market pay structures, with individual salaries determined by factors such as business needs, market conditions, internal equity, and based on the candidate&rsquo;s relevant experience, skills and qualifications.</p><p>
For union positions, the pay range is determined by the Collective Bargaining Agreement (CBA).</p>
$49,700.00 - $59,500.00</div></div></div><p></p>

Financial Clearance Specialist

Millennium Physician Group

<div><p><b>Job Description Summary</b></p><p>
&lrm;</p>
The Geriatric Patient Care Specialist serves as a vital link between our elderly patients, their families, and the multidisciplinary care team. This role is crucial for ensuring seamless patient navigation, comprehensive administrative support, and coordination of care services, ultimately contributing to the highest quality of patient outcomes.<p>
&lrm;</p><p><b>
How will you make an impact &amp; Requirements</b></p><p>
&lrm;</p><div><div><p><b>
Key Responsibilities</b></p></div><div><ul><li><p>
Appointment Management: Coordinate, schedule, and confirm new and existing patient appointments using systems like Athena and Carelink; place reminder calls to patients.</p></li></ul></div><div><ul><li><p>
Patient and care coordination</p></li></ul></div><div><ul><li><p>
Liaison/Communication: Act as the primary liaison, communicating regularly with patients, family members, and various providers and care teams (including specialists, PCPs, home health, and hospice agencies).</p></li></ul></div><div><ul><li><p>
Case Management &amp; Referrals:</p></li></ul></div><div><ul><li><p>
Coordinate and schedule post-discharge visits for patients returning home from the hospital or skilled nursing facilities (SNF).</p></li></ul></div><div><ul><li><p>
Monitor and manage the coordination of new patient referrals, specifically for house calls.</p></li></ul></div><div><ul><li><p>
Process and track specialized referrals (e.g., specialists, home health, hospice, psychiatry), including faxing orders/referral packets and progress notes, and following up to confirm acceptance and scheduling.</p></li></ul></div><div><ul><li><p>
Program Enrollment: Enroll eligible patients in Advanced Primary Care Management (APCM), creating the necessary profiles and uploading consent forms; accurately document time spent on APCM tasks (e.g., home health orders, prescription management, phone calls).</p></li></ul></div><div><ul><li><p>
GUIDE Program Management: Track referrals, discuss program details with patients, and set up in-person or telehealth visits, including confirming insurance and location details.</p></li></ul></div><div><ul><li><p>
NP/Provider Support: Screen and return phone calls to family members on behalf of the Nurse Practitioner (NP).</p></li></ul></div><p></p><div><p><b><br>
Administrative</b><b> </b><b>and Documentation</b></p></div><div><ul><li><p>
Patient Registration &amp; Data Entry: Perform patient registration, creating profiles in Athena, and accurately adding/verifying patient demographics, new patient insurance, and billing information. Upload admission packets as needed.</p></li></ul></div><div><ul><li><p>
Census Management: Maintain and track provider census data, monitoring patient appointment cadence, referral status, and ensuring accurate provider and regional assignments in Athena and other tracking systems.</p></li></ul></div></div><div><div><ul><li><p>
Insurance Verification &amp; Authorization:</p></li></ul></div><div><ul><li><p>
Verify patient insurance benefits.</p></li></ul></div><div><ul><li><p>
Obtain necessary insurance authorizations for specialist referrals, APCM, Transitional Care Management (TCM) services, and medications.</p></li></ul></div><div><ul><li><p>
Documentation: Document after-hours call notes in the patient chart.</p></li></ul></div><div><ul><li><p>
General Administration: Assist with tasks related to practice capacity, general letters, and processing provider requests/orders.</p></li></ul></div><p></p><div><p><b><br>
Clinical Support and Processing</b></p></div><div><ul><li><p>
Orders Processing (Lab, Radiology, DME):</p></li></ul></div><div><ul><li><p>
Process lab and radiology orders, including faxing orders and demographics for mobile imaging.</p></li></ul></div><div><ul><li><p>
Manage the Lab bucket by labeling/assigning reports and contacting patients to deliver lab results on behalf of the NP.</p></li></ul></div><div><ul><li><p>
Complete and process Durable Medical Equipment (DME) orders, add addenda to progress notes, fax the order and face sheet to the vendor, and call to confirm receipt.</p></li></ul></div><div><ul><li><p>
Medication Assistance: Verify medication dosage and frequency in the EHR and submit prescription refills on behalf of the NP. Send orders for acute issues to Assisted/Independent Living facilities (AL/IL) on behalf of the NP.</p></li></ul></div><div><ul><li><p>
Medical Records: Send medical records requests on behalf of the NP; fax progress notes and records to specialists, PCPs, home health, and hospice agencies for care coordination.</p></li></ul></div><div><ul><li><p>
Compliance: Track and manage death certificate requests. Send home health certifications to the Central Business Office (CBO). Serve as a liaison for unprocessed medical records requests between HealthMark and the patient/requestors.</p></li></ul></div><p></p><div><p><b><br>
Qualifications</b></p></div><div><ul><li><p>
Experience: Previous experience in a healthcare administrative or patient care coordination role is preferred, especially in a geriatric or primary care setting.</p></li></ul></div><div><ul><li><p>
Technical Skills: Proficiency with Electronic Health Record (EHR) systems (e.g., Athena) and scheduling platforms (e.g., Carelink).</p></li></ul></div><div><ul><li><p>
Knowledge: Strong understanding of medical terminology, insurance verification, authorization processes, and common clinical workflows (e.g., lab orders, referrals, prescription refills).</p></li></ul></div><div><ul><li><p>
Attributes: Exceptional organizational skills, attention to detail, strong verbal and written communication, and a compassionate, patient-centered approach.</p></li></ul></div></div></div>

Geriatric Patient Engagement

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