Prior Authorization professional Job at Daley and Associates

Trainee Client Partner - Prior Authorization

Give your career a boost by becoming a Trainee Client Partner for Prior Authoriz...

Location

Philippines , McKinley Hill, Taguig and Cebu City

Salary:

Not provided

Access Healthcare LLC

Expiration Date

Until further notice

Requirements

Bachelor's/College Degree, Post Graduate Diploma / Master's Degree, Professional License (Passed Board/Bar/Professional License Exam), Post Graduate Diploma / Master's Degree of the following medical allied courses: Medicine
Nursing
Physical Therapy
Pharmacy
Biology/ Human Biology
Medical Technology
Radiologic Technology
No work experience required
Preferably with BPO experience
Excellent communication skills

Job Responsibility

Conduct outbound calls to providers
To obtain authorization of specific medical procedure or prescription drug and to check on patient’s eligibility, benefits, and coverage
Document the call notes and take appropriate action on the revenue cycle system

Um pharmacy technician

The UM Pharmacy Technician is responsible for the intake and review of prior aut...

Location

United States

Salary:

42600.00 - 65960.00 USD / Year

Healthfirst

Expiration Date

Until further notice

Requirements

High School Diploma or GED from an accredited institution
Either nationally certified Pharmacy Technician in good standing (i.e., PTCB, NHA) or registered or licensed Pharmacy Technician in good standing
Experience conducting prior authorization reviews
Experience requiring written, verbal, and telephonic communication in English that is clear, concise, grammatically correct, and professional

Job Responsibility

Reviews prior authorization requests and units for medications requested under the medical benefit
Assesses provider-submitted clinical information for clinical appropriateness based on predetermined clinical criteria
Sends notification to members and providers of authorization decisions via telephone, fax, or mail
Ensures prior authorization reviews are conducted within timeframes set forth by CMS and/or NYSDOH
Establishes great rapport with Provider offices via telephonic communication
Sends request for information sheets to Providers
Ensures that patient information is shared appropriately maintaining confidentiality and compliance with federal law and HIPAA regulations
Additional duties as necessary

What we offer

medical, dental and vision coverage, incentive and recognition programs, life insurance, and 401k contributions

Fulltime

Clinical UM Pharmacist

The Clinical UM Pharmacist is a dynamic position responsible for the review of p...

Location

United States

Salary:

88700.00 - 149430.00 USD / Year

Healthfirst

Expiration Date

Until further notice

Requirements

Pharmacy degree from an accredited school of pharmacy
Registered Pharmacist with a state license in good standing
Work experience conducting prior authorization reviews
Clinical knowledge of pharmaceuticals and disease states in order to conduct prior authorization reviews
Work experience requiring written and verbal clinical communication that is clear, concise, grammatically correct, and professional
Knowledge of specialty pharmaceuticals and billing practices in the medical and pharmacy benefits

Job Responsibility

Monitor and review prior authorization requests for medications
Calculate appropriate billable units based on dosing, indication, weight, BMI and other clinical considerations
Develop clinical criteria and medical policies for the review of medications
Ensure all clinical criteria is in compliance with Center of Medicare and Medicaid Services (CMS) and the New York State Department of Health (NYSDOH)
Research drug information to maintain drug knowledge and disease state understanding for application to prior authorization reviews
Ensure prior authorization reviews are conducted in timeframes set forth by CMS and/or NYSDOH
Work across departments as needed to complete Utilization Management reviews
Review monthly reports and provide feedback on trends, ideas for efficiency, and innovation
Ability to work well in a team environment and be a team player
Additional duties as assigned or required

What we offer

medical, dental and vision coverage, incentive and recognition programs, life insurance, and 401k contributions

Fulltime

Pharmacy Access Representative III

Manages medication coordination and removal of barriers that prevent patients fr...

Location

United States of America , Rochester

Salary:

21.71 - 29.31 USD / Hour

University of Rochester

Expiration Date

Until further notice

Requirements

Associate's degree in a Medical, Secretarial or related field and 4 years of relevant experience required
Or equivalent combination of education and experience
Capable of working independently with minimum supervision required
Strong communication skills, problem-solving abilities, and professional presentation required
Demonstrated customer relations skills required
Ability to multi-task, manage many details with accuracy, work under pressure, and maintain a professional attitude required
Completed ASHP-accredited training program or equivalent experience as a pharmacy technician upon hire preferred
Certification from a nationally accredited pharmacy technician certification program (Currently PTCB) and maintain ongoing education requirements upon hire preferred

Job Responsibility

Manages medication coordination and removal of barriers that prevent patients from receiving their medications
Communicates with the prescriber's office to acquire necessary information to submit prescriptions to the patient's insurance for approval including prior authorization, and helps enroll patients in financial assistance programs and arrange timely delivery of the medication
Facilitates communication between the patient, pharmacist, insurance, and staff to ensure coordinated care
Maintains expertise on all potential patient assistance programs (PAP), grants, foundations, and coupons relevant to the high-cost drugs prescribed in their assigned area(s)
Analyzes patients that are receiving high-cost medications for potential participation in PAPs, and identifies the best options for the patient given their overall circumstances
Coordinates with the patient and/or family to obtain necessary information, including income information and other personal details, as well as to present PAP options to the patient/family when there are multiple options
Enrolls patients in PAPs using the needed permission and information, follows up to determine the status of the application, and ensures proper documentation of this process
Submits all required documentation to the PAP throughout the duration of treatment to verify that payment for each prescription refill is still active
Understands and manages the payment process specific to each PAP, and ensures that payments are properly accounted for the correct patient and correct patient encounter
Meets or discusses with the patient and/or family the status of PAP eligibility on an as-needed basis if coverage changes during treatment duration

Fulltime

Pharmacy Access Representative III - Specialty Pharmacy

As a community, the University of Rochester is defined by a deep commitment to M...

Location

United States of America , Rochester

Salary:

21.71 - 29.31 USD / Hour

University of Rochester

Expiration Date

Until further notice

Requirements

Associate’s degrees in a Medical, Secretarial, or related field and 4 years of relevant experience required
Capable of working independently with minimum supervision required
Strong communication skills, problem-solving abilities, and professional presentation required
Demonstrated customer relations skills required
Ability to multi-task, manage many details with accuracy, work under pressure, and maintain a professional attitude required
Completed ASHP-accredited training program or equivalent experience as a pharmacy technician preferred
Certification from a nationally accredited pharmacy technician certification program (Currently PTCB) and maintain ongoing education requirements preferred

Job Responsibility

Manages medication coordination and removal of barriers that prevent patients from receiving their medications
Communicates with the prescriber’s office to acquire necessary information to submit prescriptions to the patient’s insurance for approval including prior authorization
Helps enroll patients in financial assistance programs and arrange timely delivery of the medication
Facilitates communication between the patient, pharmacist, insurance, and staff to ensure coordinated care
Maintains expertise on all potential patient assistance programs (PAP), grants, foundations, and coupons relevant to the high-cost drugs prescribed in their assigned area(s)
Analyzes patients that are receiving high-cost medications for potential participation in PAPs
Coordinates with the patient and/or family to obtain necessary information
Enrolls patients in PAPs
Submits all required documentation to the PAP throughout the duration of treatment
Understands and manages the payment process specific to each PAP

Fulltime

Prior Authorization Coordinator

We are looking for a dedicated Prior Authorization Coordinator to join our team ...

Location

United States , St. Louis Park

Salary:

Not provided

Robert Half

Expiration Date

Until further notice

Requirements

Proven experience in medical billing and prior authorizations within a healthcare setting
Strong understanding of insurance verification processes and claims management
Familiarity with Epic EMR system for documentation and tracking purposes
Excellent organizational skills and attention to detail in handling patient accounts
Ability to communicate professionally with patients, providers, and insurance representatives
Knowledge of healthcare regulations and compliance standards
Problem-solving skills to address billing and authorization challenges
Ability to work independently and collaboratively in a fast-paced environment

Job Responsibility

Process and manage prior authorization requests with accuracy and efficiency
Verify insurance coverage and eligibility to ensure proper billing procedures
Handle medical claims submissions and follow up on outstanding claims
Collaborate with healthcare providers to resolve patient account inquiries
Utilize Epic EMR to document and track patient information and authorization statuses
Investigate and resolve issues related to medical collections and billing discrepancies
Maintain compliance with healthcare regulations and insurance policies
Communicate effectively with patients regarding their account status and authorization requirements
Work closely with insurance companies to expedite approvals and resolve any delays
Provide support in analyzing patient account data to identify trends and areas for improvement

What we offer

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

Senior Field Reimbursement Specialist

Under general supervision of a Senior Manager, the Sr Field Reimbursement Specia...

Location

United States , Remote

Salary:

100700.00 - 155100.00 USD / Year

Cencora

Expiration Date

Until further notice

Requirements

Experience related and progressively responsible in a medical practice, private or third-party reimbursement arena, or pharmaceutical industry in sales, managed care, or clinical support
Experience within healthcare provider support such as a physician practice, patient assistance program or similar pharmaceutical/biological support program experience preferred
Bachelor’s degree preferred
Minimum of 7 years of experience
Candidates must possess a Prior Authorization Certification Specialist (PACS) credentials from an industry approved licensing body, or obtain certification within the first six months of employment
Ability to effectively manage multiple client relationships and customer
Ability to manage and support external meetings, presentations, and client interactions
Ability to lead and work in a matrix environment
Proven teamwork and collaboration skills with a demonstrated record of accomplishment of working in highly matrixed and cross-functional organizations
Ability to manage multiple tasks, timelines, expenses, and other activities necessary to fulfill the roles and responsibilities of a Field Reimbursement Specialists

Job Responsibility

Plan and engage with customers, leveraging client approved resources, to educate on access and reimbursement topics relevant to assigned client’s product
Track progress and evaluate results of assigned activities
Recommends changes in procedures
Lead or direct more complex projects or certain aspects of projects
Operates with reasonable latitude for un-reviewed action or decision
Work within a matrix environment to collaborate with internal and external stakeholders to secure optimized patient access and provide appropriate education through a focused effort on healthcare providers in community, institutional, and academic medical settings
Manage daily activities that support appropriate patient access to our client’s products in the provider offices and healthcare institutions, working as a liaison to other patient assistance and reimbursement support services offered by our clients
Review patient insurance benefit options with appropriate authorizations
Validate prior authorization requirements
Understanding of Specialty Pharmacy processes

What we offer

medical
dental
vision care
comprehensive suite of benefits that focus on the physical, emotional, financial, and social aspects of wellness
support for working families
backup dependent care
adoption assistance
infertility coverage
family building support
behavioral health solutions

Fulltime

Retail Pharmacy Technician

Location

United States , Oconomowoc

Salary:

21.85 - 32.80 USD / Hour

Advocate Aurora Health

Expiration Date

Until further notice

Requirements

Pharmacy Technician certification (CPhT) issued by the Pharmacy Technician Certification Board needs to be obtained within 2 years
Pharmacy Technician Certified (ExCPT) issued by the National Healthcareer Association needs to be obtained within 2 years
If working in WI: Registered as a Pharmacy Technician through Wisconsin Department of Safety and Professional Services, application must be submitted prior to start date
If working in IL: Registered as a Pharmacy Technician through Illinois Department of Financial and Professional Regulation, application must be submitted prior to start date with license obtained within 60 days of date of submission
High School Graduate
No experience required
Good Mathematic skills
Attention to details
Good customer service, communication, organization, problem resolution and process development skills
Basic computer skills

Job Responsibility

Develops competency in servicing pharmacy customers including obtaining and recording initial demographic and other required information, data entry of required information into the pharmacy system for record keeping, insurance verification and label generation purposes, and cashiering
Develops competence in dispensing and delivery of medications. This includes developing competence in the department’s us of information systems, technology, and automation use for dispensing, storage of medications and clerical duties
Develop competence in insurance and third party billing functions including: data entry of customer demographics and third-party information, obtaining prior authorizations from appropriate third-party carriers, maintaining files of prior authorization, investigating and correcting errors in submission to third parties and handling private insurance, workers compensation, and third-party insurance coverage and prescription-related issues
Develops competence in clinical support needs such as but not limited to DIR fees
If applicable per assigned work location and workflow scope, will promote the sale of and assist customers in the appropriate selection and fitting of diabetic footwear, submit insurance billing (Medicare, Medicaid, and commercial), as well as maintain documentation records
If applicable, float technician develops competency in pharmacy workflow across multiple Aurora Pharmacy locations
Develops competence in pharmacy procedures and documentation as required, satisfying legal, regulatory, and department requirements of pharmacy practice
Complies with legal, regulatory, accreditation standards. This includes (but is not limited to) controlled substance procedures and USP requirements
Must be able to demonstrate knowledge and skills necessary to provide care appropriate to the age of the patients served. 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's status and interpret the appropriate information needed to identify each patient's requirements relative to his/her age-specific needs, and to provide the care needed as described in the department's policies and procedures. Age-specific information is developed further in the departmental job standards.

What we offer

Paid Time Off programs
Health and welfare benefits such as medical, dental, vision, life, and Short- and Long-Term Disability
Flexible Spending Accounts for eligible health care and dependent care expenses
Family benefits such as adoption assistance and paid parental leave
Defined contribution retirement plans with employer match and other financial wellness programs
Educational Assistance Program

Parttime

Prior Authorization professional

Daley and Associates

Location:
United States

Category:
-

Contract Type:
Not provided

Salary:

Job Description:

Requirements:

Additional Information:

Job Posted:
March 21, 2026

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