Medical Services Coordinator – Prior Authorizations Job at Robert Half (Edmond)

Prior-Authorization Coordinator

Location

United States , Englishtown

Salary:

Not provided

Robert Half

Expiration Date

Until further notice

Requirements

Knowledge of medical terminology and insurance requirements

Job Responsibility

Obtain prior authorizations for procedures, medications, and diagnostic services
Verify patient insurance coverage, benefits, and eligibility
Communicate with insurance companies to submit and follow up on authorization requests
Review clinical documentation for completeness and accuracy prior to submission
Track authorization status and ensure approvals are received prior to scheduled services

What we offer

paid time off
medical health insurance
dental
vision
life insurance
401(k) plan

Prior-Authorization Coordinator

Location

United States , Englishtown

Salary:

Not provided

Robert Half

Expiration Date

Until further notice

Requirements

Knowledge of medical terminology and insurance requirements.

Job Responsibility

Obtain prior authorizations for procedures, medications, and diagnostic services
Verify patient insurance coverage, benefits, and eligibility
Communicate with insurance companies to submit and follow up on authorization requests
Review clinical documentation for completeness and accuracy prior to submission
Track authorization status and ensure approvals are received prior to scheduled services.

What we offer

paid time off
medical health insurance
dental
vision
life insurance

Prior Authorization Coordinator

The Prior Authorization Coordinator plays a critical role in ensuring timely acc...

Location

United States , Minneapolis

Salary:

Not provided

Robert Half

Expiration Date

Until further notice

Requirements

High school diploma or equivalent required
Associate’s or Bachelor’s degree preferred
Previous experience in a healthcare administration, medical billing, or insurance authorization role
Knowledge of medical terminology, ICD and CPT coding, and health insurance procedures
Excellent organizational and time management skills
Strong verbal and written communication skills
Proficient with electronic health records (EHR) and authorization portals

Job Responsibility

Review and process prior authorization requests for medical services, procedures, and medications
Gather and compile relevant documentation from medical records to support authorization requests
Submit authorization requests to insurance companies and follow up on pending approvals
Communicate authorization status updates to providers and patients and escalate urgent cases as needed
Respond to payer inquiries, request additional information, and manage appeals for denied claims
Maintain accurate records of submitted requests, outcomes, and correspondence
Collaborate with medical and administrative teams to resolve issues and maintain workflow efficiency

What we offer

medical, vision, dental, and life and disability insurance
eligible to enroll in our company 401(k) plan

New

Bilingual Patient Services Representative

Location

United States , Miami

Salary:

Not provided

Robert Half

Expiration Date

Until further notice

Requirements

Bilingual English/Spanish required
2+ years of healthcare administration, patient services, or medical office experience
Experience with insurance verification, referrals, and authorizations
Familiarity with EMR/EHR systems such as Epic, Cerner, eClinicalWorks, or similar
Strong customer service, communication, and problem-solving skills

Job Responsibility

Coordinate patient scheduling and appointment management across multiple providers
Verify insurance eligibility, benefits, and coverage requirements
Process referrals and prior authorizations with insurance carriers and provider offices
Educate patients on appointment requirements, insurance information, and financial responsibilities
Maintain accurate patient records and documentation within EMR/EHR systems
Collaborate with clinical and administrative teams to ensure continuity of care
Resolve patient concerns and assist with complex scheduling and account-related inquiries

What we offer

medical
vision
dental
life and disability insurance
enrollment in company 401(k) plan

New

Medical Customer Service Rep

We are looking for a compassionate and detail-oriented Medical Customer Service ...

Location

United States , Minneapolis

Salary:

Not provided

Robert Half

Expiration Date

Until further notice

Requirements

Previous experience in a call center or customer service role, preferably within healthcare or health insurance
Working knowledge of Medicaid, Medicaid eligibility, claims processing, and member service practices
Familiarity with prior authorization processes and provider network navigation
Strong verbal communication skills with the ability to explain complex benefit information in a simple, helpful manner
Comfortable managing a high volume of calls while maintaining accuracy, professionalism, and attention to detail
Ability to document information clearly and use customer service systems efficiently
Proven ability to handle sensitive situations with patience, discretion, and a member-focused approach

Job Responsibility

Handle incoming calls from health plan members and provide clear explanations related to coverage, benefits, and claim status
Assist callers with questions about amounts owed, including billing concerns and statements issued by healthcare providers
Review member eligibility details and help individuals understand Medicaid-related services and managed care plan information
Guide members through provider network options so they can identify appropriate participating healthcare professionals and facilities
Explain medical authorization guidelines and help members understand when prior approval may be required for certain services
Support members with coordinating transportation arrangements and navigating scheduling options tied to their health plan benefits
Document customer interactions thoroughly and maintain accurate records of inquiries, actions taken, and follow-up needs
Deliver empathetic, high-quality service while meeting standards in a high-volume customer support environment

What we offer

medical
vision
dental
life and disability insurance
401(k) plan

Fulltime

New

Patient Financial Access Facilitator

We are looking for a Patient Financial Access Facilitator to support front-end p...

Location

United States , New Haven

Salary:

Not provided

Robert Half

Expiration Date

Until further notice

Requirements

Prior experience in patient registration, healthcare scheduling, medical front desk support, or a related patient access function
Working knowledge of insurance verification, benefit review, co-pay collection, and financial clearance processes
Strong customer service and communication skills with the ability to remain detail-oriented in a busy, patient-facing environment
Ability to use multiple applications and online tools to complete registration, scheduling, and documentation tasks accurately
Familiarity with healthcare policies, confidentiality standards, and regulatory requirements affecting patient access and billing
Strong attention to detail with the ability to identify discrepancies, resolve routine issues, and maintain high-quality records
Ability to collaborate effectively with clinical teams, administrative staff, and patients from diverse backgrounds

Job Responsibility

Manage patient check-in and check-out activities by entering, reviewing, and updating demographic, coverage, and account details with a high level of accuracy
Schedule and adjust appointments based on provider availability, visit type, timing requirements, and patient needs while coordinating closely with clinical staff
Confirm patient identity and follow established safety and fraud-prevention procedures to protect patients and maintain compliance standards
Verify insurance eligibility, enter coverage information correctly, and support billing readiness by securing complete and accurate financial data
Collect co-pays, outstanding balances, and required documentation, including signatures and authorizations, in line with departmental policies
Assist patients who need additional support, including individuals with language, hearing, or accessibility needs, to help ensure an inclusive registration experience
Monitor wait lists, recalls, and open appointment slots to improve scheduling efficiency and help maximize clinic utilization
Document visit-related details thoroughly in the appropriate systems and maintain organized records that support operational and reimbursement requirements

What we offer

medical
vision
dental
life and disability insurance
401(k) plan

Genetic Counseling Assistant I- Neurology

Join licensed genetic counselors in a growing Neurogenetics Program with special...

Location

United States , Brookline

Salary:

21.47 - 33.55 USD / Hour

Boston Children's Hospital

Expiration Date

Until further notice

Requirements

Bachelor’s degree, preferably in Biological Science, Clinical Laboratory Science or related scientific field, Advocacy and Social Sciences
One year of experience in a laboratory setting or healthcare, public service or insurance customer service setting is preferred
Spanish fluency preferred
Ability to communicate effectively both orally and in writing and provide empathy in difficult interpersonal situations
Ability to gather and synthesize data, resources, and literature related to relevant genes, variants, diagnoses and test results
Ability to demonstrate professional behavior by adhering to departmental and organizational policies and procedures, and assuming authority appropriately
Analytical skills and judgment to interpret data and take the appropriate action in circumstances or situations that vary

Job Responsibility

Triages genetic counseling referrals, phone calls, and emails, coordinating with program PER and schedulers to ensure timely and accurate patient scheduling
Performs pre-visit preparation, including collecting medical records, lab reports, estimates, and intake forms
Responds to post-visit questions regarding genetic testing and sample status
escalates genetic counseling questions to the appropriate Genetic Counselor (GC)
Assists with obtaining consent from additional family members under supervision
Coordinates genetic testing logistics, including identifying laboratories, researching submission requirements, arranging shipment of testing kits, and submitting required medical records
Tracks genetic testing samples and follows up on missing samples, documentation, or patient information with patients, GCs, laboratories, and providers
Submits and tracks prior authorizations and appeals, including letters of medical necessity, supporting clinical documentation, CPT/ICD-10 coding, and peer-to-peer coordination with insurance providers
Completes genetic testing requisition forms, including review of pedigrees and assignment of diagnosis codes
Maintains patient testing databases and ensures results are accurately entered into program systems

What we offer

flexible schedules
affordable health, vision and dental insurance
child care and student loan subsidies
generous levels of time off
403(b) Retirement Savings plan
Pension
Tuition and certain License and Certification Reimbursement
cell phone plan discounts
discounted rates on T-passes

Fulltime

Utilization Review Nurse Health Plans - HP Utilization Management

The Utilization Review Nurse is responsible for determining the clinical appropr...

Location

United States , Irving

Salary:

Not provided

CHRISTUS Health

Expiration Date

Until further notice

Requirements

Graduate of an accredited school of vocational nursing or equivalent required
Associate’s (ADN) or Bachelor’s (BSN) in Nursing preferred
3 – 5 years of nursing experience preferred
Experience in Microsoft software (e.g., Outlook, Teams, Word, and Excel) required
General computer knowledge and capability to use computers required
LVN license in the state of employment or compact required
RN license in state of employment or compact preferred

Job Responsibility

Meets expectations of the applicable OneCHRISTUS Competencies: Leader of Self, Leader of Others, or Leader of Leaders
The prior authorization role completes an assessment of a proposed service to determine if the beneficiary has eligible coverage for the service and if it is medically necessary
Promote quality, cost-effective outcomes through prior authorization and concurrent review of requested services for medical necessity based upon evidence-based clinical guidelines
Identify and present cases of possible quality of care deviations, questionable admissions, and prolonged lengths of stay to the Medical Director for further determination
Appropriately refer beneficiaries who have complex or chronic conditions, a need for transition of care, disease management support, or other identifiable needs for coordination of the beneficiary’s member’s health care for behavioral health care management
Follow CHRISTUS Health Guidelines related to the Health Insurance Portability and Accountability Act (HIPAA), designed to prevent, or detect unauthorized disclosure of Protected Health Information (PHI)
Protect the confidentiality of data and intellectual property
assures compliance with national health information guidelines
Analyze clinical information submitted by medical providers to evaluate the medical necessity, appropriateness, and efficiency of the use of medical services, procedures, and facilities
Perform provider outreach to address post-hospital discharge services, redirection to in-network providers for appropriate steerage, durable equipment usage, and utilization of other medical services and/or procedures and other necessary telephonic follow-up

Fulltime

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Medical Services Coordinator – Prior Authorizations

Job Description

Job Responsibility

Requirements

What we offer

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