Top 17 Authorization and appeals specialist Jobs in Columbus

Prior Authorization Specialist
Equitas Health, Inc. —Columbus, OH
- $18.13 - $21.78 an hour
- Weekends as needed
- Mid-level
- Driver's License
- Driving
- Dental insurance
- 401(k)
Quick Apply
BH Insurance/Precert Specialist
Nationwide Children's Hospital —Columbus, OH
- Full-time
- CPR Certification
- BLS Certification
- High school diploma or GED
Medical Billing and Accounts Receivable Specialist
I Am Boundless, Inc. —Worthington, OH
- Full-time
- Remote
- Computer literacy
- Mid-level
- Microsoft Office
Quick Apply
Insurance Verification and Prior Auth Specialist
Ohio Gastroenterology Group —Columbus, OH
- Hybrid work
- Microsoft Excel
- HIPAA
- English
Quick Apply
1d
Physcian Office Specialist
OhioHealth —Columbus, OH
- Full-time
- High school diploma or GED
- Cleaning
- Communication skills
7d
Physician Office Specialist
OhioHealth —Bexley, OH
- Full-time
- High school diploma or GED
- Cleaning
- Communication skills
Physician Office Specialist Part-Time Casual
OhioHealth —Dublin, OH
- Part-time
- High school diploma or GED
- Cleaning
- 1 year
Physician Office Specialist - Grant, Orthopedic Surgeons
OhioHealth —Columbus, OH
- Full-time
- Mid-level
- High school diploma or GED
- Cleaning
7d
Physician Office Specialist - Bing Cancer Center
OhioHealth —Columbus, OH
- Full-time
- Mid-level
- High school diploma or GED
- Cleaning
7d
Office Specialist Endocrinology
OhioHealth —Westerville, OH
- Full-time
- High school diploma or GED
- Cleaning
- Communication skills
Physician Office Specialist- Vascular Surgery
OhioHealth —Columbus, OH
- Full-time
- Microsoft Excel
- Surgery
- Mid-level
Physician Office Specialist - PCP Davidson Dr
OhioHealth —Reynoldsburg, OH
- Full-time
- High school diploma or GED
- Cleaning
- Communication skills
Dental Claims Specialist
The Ohio State University —Columbus, OH
- $18.37 - $23.99 an hour
- Full-time
- Background check
- Pass drug screening
- Office

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Prior Authorization Specialist
Equitas Health, Inc. —Columbus, OH
Reliable transportation, driver’s license and proof of auto insurance required. Essential job functions include, but are not limited to, driving or having…
$18.13 - $21.78 an hour
Quick Apply
BH Insurance/Precert Specialist
Nationwide Children's Hospital —Columbus, OH
CPR certification (based on position and as determined by manager). Assists with the retrospective review of records for patients who have insurance changes…

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Prior Authorization Specialist

Equitas Health, Inc. -
Columbus, OH

Quick Apply

Job Details

$18.13 - $21.78 an hour

Benefits

Dental insurance
401(k)
Paid time off
Vision insurance

Qualifications

Care documentation
Driver's License
Cultural competency
Driving
Working with individuals from diverse cultural backgrounds
Documentation Handling

Full Job Description

ORGANIZATION INFORMATION:

Established in 1984, Equitas Health is a regional not-for-profit community-based healthcare system and federally qualified community health center look-alike. Its expanded mission has made it one of the nation’s largest HIV/AIDS, lesbian, gay, bisexual, transgender, and queer/questioning (LGBTQ+) healthcare organizations. With 22 offices in 12 cities, it serves more than 67,000 individuals in Ohio, Kentucky, and West Virginia each year through its diverse healthcare and social service delivery system focused around: primary and specialized medical care, retail pharmacy, dental, behavioral health, HIV/STI prevention, advocacy, and community health initiatives.

HOURLY RATE: $18.13-$21.78

BENEFITS:

PTO
Vision
Dental
Health
401k
Sick time

POSITION SUMMARY:
The Prior Authorization Specialist handles all prior authorizations, third party appeals, and pending third party payer issues across all Equitas Health medical centers. This individual will work with internal and external pharmacies, CoverMyMeds, the EHR, and all Equitas Health health center providers to facilitate prior authorization completion. This individual must be able to work in conjunction with the pharmacy department and health center staff to facilitate the prior authorization process.

ESSENTIAL JOB FUNCTIONS:
The Prior Authorization Specialist is responsible for handling all prior authorizations, appeals, and third party medication disputes for providers at Equitas Health. The Prior Authorization Specialist will be required to communicate with prescribers, pend medication changes, and maintain exceptional documentation in the patient health record. The staff member will also be in constant communication with internal pharmacies, external pharmacies, and patients waiting on prior authorizations. Essential job functions include, but are not limited to, driving or having reliable transportation, written and verbal communication, utilizing a computer for typing, multi-system use/maintenance, and attending meetings.

MAJOR AREAS OF RESPONSIBILITIES:

Complete prior authorizations submission within established time frame.
Collaborate with providers to manage appeals and/or peer-to-peer discussion with third party representatives.
Ensure proper documentation is maintained in the EHR.
Work with clinical pharmacist team to provide potential therapeutic substitutions to prescribers
Communicate with the clinical team on the status of prior authorizations or changes that must be made for therapy to continue for the patient.
Maintain constant communication with the internal and external pharmacy teams for medication processing.
Inform patients when prior authorizations are approved.
Provide data on prior authorizations as needed to Senior Leadership.
Other duties as assigned by the Prior Authorization Supervisor, Director of Nursing, and Leadership.
Comply with the Equitas Health Care Corporate Compliance Standards of Conduct and related policies and procedures.
Demonstrate unconditional positive regard to clients and conduct all aspects of job responsibilities.
Continuously grow and develop cultural competency, exhibiting an understanding, awareness, and respect for diversity.
Contribute to a positive work environment by demonstrating unconditional positive regard to all Equitas Health employees, interns, etc. with an understanding, awareness, and respect for diversity.

EDUCATION/LICENSURE:

Medical Assistant, Certified Pharmacy Technician or Registered Pharmacy Technician (must be registered with State of Ohio Board of Pharmacy).

Knowledge, Skills, Abilities and other Qualifications:

Experience working in medical records preferred.
Must be able to accurately and effectively meet established deadlines
Experience with prior authorizations preferred.
Strong attention to detail.
Ability to be flexible in working hours.
Must ensure detailed and thorough documentation.
Exemplary written and verbal communication skills.
Knowledge of healthcare terminology.
Must have sensitivity to, interest in and competence in cultural differences, HIV/AIDS, minority health, sexual practices, chemical dependency and a demonstrated competence in working with persons of color, and gay/lesbian/bisexual/transgender community.
Proficiency in all Microsoft Office applications, computers, email, web-based systems and electronic health records.
Reliable transportation, driver’s license and proof of auto insurance required.

OTHER INFORMATION:

Background and reference checks will be conducted. In accordance with Equitas Health’s Drug-Free Workplace Policy, pre-employment drug testing will be administered. Hours may vary, including working some evenings and weekends based on workload. Individuals are not considered applicants until they have been asked to visit for an interview and at that time complete an application for employment. Completing the application does not guarantee employment. EOE/AA

Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities
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 (https://www.eeoc.gov/poster) notice from the Department of Labor.

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Refine Your Search

authorization and appeals specialist jobs in columbus

Prior Authorization Specialist

BH Insurance/Precert Specialist

Medical Billing and Accounts Receivable Specialist

Insurance Verification and Prior Auth Specialist

Physcian Office Specialist

Physician Office Specialist

Physician Office Specialist Part-Time Casual

Physician Office Specialist - Grant, Orthopedic Surgeons

Physician Office Specialist - Bing Cancer Center

Office Specialist Endocrinology

Physician Office Specialist- Vascular Surgery

Physician Office Specialist - PCP Davidson Dr

Dental Claims Specialist

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