Top 26 Prior authorization specialist Jobs in Cleveland Oh

Pharmacy Support Liaison, Bolwell
University Hospitals —Cleveland, OH
- $22.22 - $34.76 an hour
- Medical office experience
- Mid-level
- 3 years
Medical Scribe
Oak Street Health —Cleveland, OH
- $17.00 - $28.46 an hour
- Full-time
- Computer literacy
- HIPAA
- Clinic
- Health insurance
- Dental insurance
Medical Scribe
Oak Street Health —Cleveland, OH
- $17.00 - $28.46 an hour
- Full-time
- Computer literacy
- HIPAA
- Clinic
- Health insurance
- Dental insurance
Medical Scribe
Oak Street Health —Cleveland, OH
- $17.00 - $28.46 an hour
- Full-time
- Computer literacy
- HIPAA
- Clinic
- Health insurance
- Dental insurance
Medical Scribe
Oak Street Health —Cleveland, OH
- $17.00 - $28.46 an hour
- Full-time
- Computer literacy
- HIPAA
- Clinic
- Health insurance
- Dental insurance
Pharmacy Prior Authorization Specialist
Pharmacy Solutions Group of OH —Broadview Heights, OH
- Full-time
- Customer service
- HIPAA
- No experience needed
- Health insurance
- Dental insurance
Quick Apply
Pharmacy Support Liaison - Patient Engagement Team (Hybrid)
University Hospitals —Warrensville Heights, OH
- $22.22 - $34.76 an hour
- Medical office experience
- Mid-level
- 3 years
4d
Prior Authorization Specialist
MATRIX VIP LLC —Rocky River, OH
- $22 - $28 an hour
- Full-time
- Word processing
- Computer literacy
- Mid-level
Quick Apply
Insurance Verification Specialist
Medical Service Company —Cleveland, OH
- $20.00 - $25.05 an hour
- Full-time
- Hybrid work
- Research
- Mid-level
- Office
- Health savings account
- AD&D insurance
Quick Apply
Certified Pharmacy Technician - Support Liaison - Ambulatory Infusion Center
University Hospitals —Warrensville Heights, OH
- $22.22 - $34.76 an hour
- Hybrid work
- Medical office experience
- Mid-level
- 3 years
9d
Prior Authorization Certified Pharmacy Technician
Shields Health Solutions —Cleveland, OH
- $19.45 - $22.21 an hour
- Remote
- Microsoft Excel
- Microsoft Outlook
- Research
Quick Apply
11d
Operations Specialist
Bellefaire JCB —Shaker Heights, OH
- $29 an hour
- Full-time
- Psychiatry
- 5 years
- No high school diploma
- Wellness program
- Paid holidays
Quick Apply
9d
Clinical Service Specialist, Full-Time - Beachwood, OH
Vivo Infusion —Beachwood, OH
- $20 - $25 an hour
- Full-time
- Mid-level
- Ability to lift 50 pounds
- US work authorization
- Health savings account
- Disability insurance
Quick Apply
11d
Patient Support Advocate, Bolwell Pharmacy
University Hospitals —Cleveland, OH
- $17.56 - $27.46 an hour
- Mid-level
- Analysis skills
- Bachelor's degree
ONCOLOGY REVENUE INTEGRITY SPECIALIST
Southwest General —Middleburg Heights, OH
- Full-time
- Mid-level
- 3 years
- Associate's degree
3d
Medical Receptionist
Lake County Foot & Ankle Associates LLC —Cleveland, OH
- Full-time
- Ability to walk for extended periods
- HIPAA
- High school diploma or GED
Epic Ambulatory Bones Application Engineer Specialist - 6079188
Accenture —Cleveland, OH
- $47.85 - $57.85 an hour
- Full-time
- Remote
- 5 years
- High school diploma or GED
- US work authorization
- Disability insurance
- Health insurance
Medical Billing Specialist - Westlake
Achievement Centers for Children —Westlake, OH
- $20.62 - $25.48 an hour
- Full-time
- Children
- Entry level
- Health insurance
- Paid time off
Quick Apply
Medical Front Desk Receptionist
US Foot & Ankle Specialists —Cleveland, OH
- Microsoft Excel
- Microsoft Outlook
- HIPAA
- Paid holidays
- Disability insurance
Quick Apply
7d
Akron General - Business Office Specialist
Regent Surgical —Akron, OH
- Full-time
- BLS Certification
- HIPAA
- Mid-level
Quick Apply
5d

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Pharmacy Support Liaison, Bolwell

University Hospitals -
Cleveland, OH

Apply Now

Job Details

$22.22 - $34.76 an hour

Qualifications

Medicare
Medical office experience
PTCB Certification
High school diploma or GED
Medicaid health insurance
ICD-9
ICD-10
Medicare regulations
Centers for Medicare and Medicaid Services (CMS)
Centers for Medicare & Medicaid Services (CMS) billing regulations
Medicaid regulations
Medicaid
Medical terminology

Full Job Description

Sign on bonus: $3,000!!

A Brief Overview

The team requires a highly motivated, energetic, team player who is responsible for completing necessary functions to ensure optimal intake and reimbursement for high cost and infusion medications for patients receiving care within the UH Meds enterprise of pharmacy operations. The Pharmacy Support Liaison must have a strong knowledge of Medicare and Medicaid regulations and commercial insurer criteria for payment of home care services. Additionally, they will be responsible for verification of insurance, and benefits for Home Care Pharmacy services – inclusive of new referrals and therapy changes, adjudication of claims and obtaining the initial authorization for visits from commercial insurers. This position will work with Home Care RN Coordinators, Pharmacist and other clinical teams to ensure that required clinical documentation is obtained prior to acceptance onto service. They will also enters pertinent information into the pharmacy and/or certified home health software systems used by the enterprise. The position works closely with and is a supportive role to the Transition Specialist, Clinic Based/Distributional Pharmacists, Central Intake RN's and the Document Control Specialist.

What You Will Do

Access care management documentation systems for data entry and to support the existing programs and processes by collecting information, utilizing appropriate department policies, procedures and guidelines specific to members’ eligibility, benefits and contracts.
Perform intake of service requests from providers or members received electronically, or via telephone or fax.
Triage and respond to incoming phone calls providing information and assistance to meet the caller’s needs.
Authorize service(s) based on plan design or clinical guidelines in accordance with the department policies/guidelines.
Improve patient service experience and maximize pharmacy revenue through provision of prior authorization services on behalf of patients needing high cost medications.
Conduct patient insurance, benefits and financial investigation and verification by directly communicating with patients. Complete initial and renewal prior authorization forms, negotiate authorization status with insurers, track status of medication approval, and when necessary, alert stakeholders of denials or nonresponse.
Identify patient needs and ensure coverage of medication on their insurance plan through benefits investigation. If not covered, obtain necessary information from medical record, patient, and provider to enable justification for Patient Assistance program or copay assistance. Contact patients to provide information related to these resources.
Facilitate enrollment of patients in patient assistance programs and collaborate with social services and case management on patient assistance. Assist pharmacists with preparing letters of medical necessity and coordinating peer-to-peer conferences.
Expedite pharmacy workflow and enhance patient care by preventing therapy interruptions due to insurance issues in conjunction with pharmacists, physicians, transition care coordinators, nursing, and clinic staff. Communicate and collaborate regarding patient therapy interruptions, additional therapy monitoring requirements, and alternative care delivery setting options.
Participate in revenue cycle committees to help identify causes of denied claims and develop workflow solutions to optimize revenue capture
Facilitate staff training and competency, education and practice advancement
- Train new staff members
- Maintain a training and competency program for all staff that meets accreditation standards
- Coordinate with Pharmacy leadership to develop training experiences/competencies
- Represent the department at hospital meetings, committees, and events as requested
Patient Engagement Tele pharmacy Support:
- Answer incoming calls and respond to electronic communications
- Assist health care providers and patients by greeting them by phone; answering questions and requests; referring inquiries to the site pharmacist(s) as needed.
- Handle customer inquiries both telephonically and by email
- Research required information using available resources
- Manage and resolve customer complaints

Additional Responsibilities

Performs other duties as assigned.
Complies with all policies and standards.
For specific duties and responsibilities, refer to documentation provided by the department during orientation.
Must abide by all requirements to safely and securely maintain Protected Health Information (PHI) for our patients. Annual training, the UH Code of Conduct and UH policies and procedures are in place to address appropriate use of PHI in the workplace.

Education

High School Equivalent / GED (Required)
Bachelor's Degree in health care related or business field (Preferred)

Work Experience

3+ years Strong clinical background experience in a medical office or other health care setting (Required)

Knowledge, Skills, & Abilities

Knowledge of medical terminology and ICD9, ICD10, CPT, and DRG codes (Required proficiency)
Knowledge of third-party insurance billing practices, federal and state regulations with regard to billing and reimbursement, internal billing structure, and billing procedures (Required proficiency)
Experience with patient assistance programs (Required proficiency)

Licenses and Certifications

Certified Pharmacy Technician (CPhT) (Required Upon Hire)

Physical Demands

Standing Occasionally
Walking Occasionally
Sitting Constantly
Lifting Rarely up to 20 lbs
Carrying Rarely up to 20 lbs
Pushing Rarely up to 20 lbs
Pulling Rarely up to 20 lbs
Climbing Rarely up to 20 lbs
Balancing Rarely
Stooping Rarely
Kneeling Rarely
Crouching Rarely
Crawling Rarely
Reaching Rarely
Handling Occasionally
Grasping Occasionally
Feeling Rarely
Talking Constantly
Hearing Constantly
Repetitive Motions Frequently
Eye/Hand/Foot Coordination Frequently

Travel Requirements

Apply Now

Refine Your Search

prior authorization specialist jobs in cleveland oh

Pharmacy Support Liaison, Bolwell

Medical Scribe

Medical Scribe

Medical Scribe

Medical Scribe

Pharmacy Prior Authorization Specialist

Pharmacy Support Liaison - Patient Engagement Team (Hybrid)

Prior Authorization Specialist

Insurance Verification Specialist

Certified Pharmacy Technician - Support Liaison - Ambulatory Infusion Center

Prior Authorization Certified Pharmacy Technician

Operations Specialist

Clinical Service Specialist, Full-Time - Beachwood, OH

Patient Support Advocate, Bolwell Pharmacy

ONCOLOGY REVENUE INTEGRITY SPECIALIST

Medical Receptionist

Epic Ambulatory Bones Application Engineer Specialist - 6079188

Medical Billing Specialist - Westlake

Medical Front Desk Receptionist

Akron General - Business Office Specialist

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