Top 25 Prior authorization specialist Jobs in Novi, Mi

Prior Authorization Specialist
Cascade Hemophilia Consortium —Ann Arbor, MI
- $41,600 - $70,000 a year
- Full-time
- Background check
- Computer literacy
- HIPAA
- Health insurance
- Dental insurance
Quick Apply
Pharmacy Benefits Specialist - Mail Order Services - Full Time Days - Rochester Hills
Henry Ford Health —Rochester Hills, MI
- Full-time
- Hybrid work
- Research
- Mid-level
- Office
- Health insurance
- Dental insurance
Medical Scribe
Oak Street Health —Detroit, MI
- $17.00 - $31.30 an hour
- Full-time
- Computer literacy
- HIPAA
- Clinic
- Health insurance
- Dental insurance
11d
Infusion Prior Authorization Specialist
M.I.N.D —Farmington Hills, MI
- $19 - $25 an hour
- Full-time
- Mid-level
- High school diploma or GED
- Ability to sit for extended periods
6d
Authorization Specialist
Gift of Life Michigan —Ann Arbor, MI
- $25 an hour
- Full-time
- Microsoft Outlook
- English
- Mid-level
5d
Prior Authorization and Case Management Specialist
Michigan Healthcare Professionals, P.C. —Berkley, MI
- Full-time
- Microsoft Excel
- Microsoft Outlook
- Computer literacy
- Disability insurance
- Health insurance
Quick Apply
3d
Prior Authorization Certified Pharmacy Technician
Shields Health Solutions —Detroit, MI
- $19.45 - $22.21 an hour
- Remote
- Microsoft Excel
- Microsoft Outlook
- Research
Quick Apply
Financial Clearance Specialist II
Trinity Health Michigan —Pontiac, MI
- Part-time
- Remote
- Surgery
- 3 years
- High school diploma or GED
Referral Specialist
PACKARD HEALTH INC —Ann Arbor, MI
- Full-time
- HIPAA
- Mid-level
- High school diploma or GED
Quick Apply
Pharmacy Benefits Specialist - Specialty - Full Time Days - Rochester Hills
Henry Ford Health —Rochester Hills, MI
- Full-time
- Hybrid work
- Mid-level
- High school diploma or GED
- Home Health
- Health insurance
- Dental insurance
Insurance Specialist/Receptionist
Robert Levy MDPC —Dearborn, MI
- $20 - $23 an hour
- Full-time
- HIPAA
- High school diploma or GED
- Computer skills
- Health insurance
- Dental insurance
Quick Apply
13d
Corporate Medical Billing Specialist
NexCare WellBridge Senior Living —Brighton, MI
- $19 - $25 an hour
- Full-time
- HIPAA
- Mid-level
- Office
- Paid holidays
- Disability insurance
Quick Apply
3d
Executive Assistant, Human Resources
Wayne State University —Detroit, MI
- $65,000 - $80,000 a year
- Weekends as needed
- Background check
- 5 years
- Office
Pharmacy Billing Specialist III - On-Site
Guardian Pharmacy of Michigan —Brighton, MI
- $23 - $24 an hour
- Full-time
- HIPAA
- Research
- Mid-level
- Health savings account
- AD&D insurance
Quick Apply
Front Office Coordinator - Livonia, MI
Athletico Physical Therapy —Livonia, MI
- $15.00 - $23.50 an hour
- Overtime
- Microsoft Excel
- Microsoft Outlook
- HIPAA
- Paid parental leave
- Health savings account
9d
Front Desk Coordinator/Medical Receptionist
Brighton Vision Center —Brighton, MI
- $17 - $23 an hour
- Full-time
- Background check
- Writing skills
- Administrative experience
- Free parking
- Profit sharing
Quick Apply
6d
Patient Care Coordinator
Orthopedic Specialists of Oakland County- Physical Therapy —Bloomfield Hills, MI
- $17 - $19 an hour
- Full-time
- Administrative experience
- Organizational skills
- In-person
- Health insurance
- Dental insurance
Quick Apply
Front Office Coordinator - Dearborn Heights, MI
Athletico Physical Therapy —Dearborn Heights, MI
- $15.00 - $23.50 an hour
- Overtime
- Microsoft Excel
- Microsoft Outlook
- HIPAA
- Paid parental leave
- Health savings account
Front Office Coordinator - Ferndale, MI
Athletico Physical Therapy —Ferndale, MI
- $15.00 - $23.50 an hour
- Overtime
- Microsoft Excel
- Microsoft Outlook
- HIPAA
- Paid parental leave
- Health savings account
Patient Visit Specialist I
Trinity Health —Brighton, MI
- Full-time
- Microsoft Word
- Microsoft Excel
- Microsoft Outlook

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Prior Authorization Specialist

Cascade Hemophilia Consortium -
Ann Arbor, MI

Quick Apply

Job Details

Full-time
$41,600 - $70,000 a year

Benefits

Health insurance
Dental insurance
401(k)
Flexible spending account
Paid time off
Parental leave
Vision insurance
401(k) matching
Life insurance

Qualifications

Health insurance authorizations
Computer operation
Pharmacy Information Systems (PIS)
Insurance prior authorization
Achieving HIPAA compliance
Phone communication
Health insurance information
Pharmacy Technician License
HIPAA
Windows
Pharmacy technician experience
Health insurance
Math
Attention to detail
Desktop applications
Medicaid
Productivity software
Clinical confidentiality policies
Non-profit experience
Medical terminology
Pharmacy Technician Certification

Full Job Description

JOB SUMMARY:

The Prior Authorization and Insurance Specialist is responsible for reviewing, submitting, monitoring, and responding to issues regarding medication prior authorizations for Cascade patients. This position works closely with the Clinical Care and Pharmacy Teams on patient insurance, authorization issues, billing issues, and required forms. Reviews patient history to identify supporting documentation in the patient chart relevant to the medication up to and including medical records, prescriptions, prior authorizations, insurance information and verifications, and management of pertinent forms required for (or involved in) patient care by uploading pertinent documentation to patient charts in the relevant software programs. Works closely with patients, Hemophilia Treatment Centers, and insurance companies to obtain prior authorizations and to resolve problems.

Salary Range:

$40,020-$71,340

MINIMUM COMPETENCIES:

Education: Licensed and certified Pharmacy Technician

Experience:

a. Minimum of three years of experience in a medical or non-profit setting working with insurance companies

b. Excellent written and oral communication skills

c. Proficiency in Microsoft Office Suite

POSITION REQUIREMENTS:

Knowledgeable in medical terminology.
Proficient knowledge of major health plans and insurance processes.
Proficiency in operating a standard desktop and Windows-based computer system.
Excellent communications skills in both written and verbal forms, including proper phone etiquette. Ability to read, understand and respond to detailed written and oral instructions.
Excellent attention to detail
Ability to work collaboratively in a team-oriented environment; displays courteous and friendly demeanor.
Good organizational and time management skills to effectively juggle multiple priorities, time constraints and ever-changing situations.
Ability to exercise sound judgement and problem-solving skills.
Ability to perform mathematical calculations needed during the course of performing basic job duties.
Knowledge of the compliance aspects of clinical care and patient privacy.
Ability to handle patient and organizational information in a confidential manner.
Knowledge of or willingness to learn various software programs required by insurance companies to submit prior authorizations and check eligibility (CoverMyMeds, Availity, etc).

JOB RESPONSIBILITIES:

Coordinate with appropriate parties when necessary such as Hemophilia Treatment Center and insurance, to complete prior authorizations. Advocate for the patient to the best of our ability on the prior authorizations and when communicating with insurance companies. Professionally communicates with the ordering provider, HTC staff and representatives of insurance companies, including both oral and written communication.

Updates information in patient medical record in Cascade pharmacy software and Epic EHR with prior authorization approval or denial information; follows up with HTC as to status and/or issues with prior authorizations. Advises the HTC with potential next steps, such as appeals.

Monitors in basket, email, fax, and teams messages, and follows up on correspondence timely and accurately.

Assists in all aspects of new patient intake

Supports team with annual patient mailings and forms, coordinate with Forms Committee and Compliance about new forms, adjustments to current forms, and changes in processes.

Monitor the schedule for daily orders and coordinate with team members to dispense workload.

Complete insurance verifications for daily pharmacy orders and upcoming orders.

Assist the Pharmacy Technicians when billing issues arise, by calling insurance companies, requesting overrides (high cost overrides, Pillar and SaveOn overrides) when necessary, updating insurance processing information in the internal system, or provide general help getting a claim to process.

Develops, implements and revises electronic forms via HIPAA compliant software, working in conjunction with the Forms Committee

Monitors and manages electronic form responses and files into EMR accordingly

Keep up to date with insurance changes and requirements.

Advise the Pharmacists and Clinical Care team when questions come up regarding insurance coverage for a new medication, dose change, out of pocket costs, or other prior authorization/insurance questions.

Inform the HTC when new insurance is discovered for a patient of theirs and advise them of next steps to get medication covered. Discuss whose program the patient will be on with the HTC.

Monitor monthly PA expirations, verify active insurance, and create referrals in current software. Assign the PA referrals to the appropriate team member to ensure PA’s are submitted in a timely manner to avoid interruptions in patient care.

Monitor necessary letters of medical necessity. Coordinate with the HTC’s to facilitate renewals and new letters of medical necessity as applicable.

Be able to identify underinsured new or current patients, and coordinate with Patient Access team for support.

Supports other teams as needed such as answering telephones when necessary, filing paperwork, etc.

Participates in 340B trainings.

Participate in weekend on-call schedule, covering holidays in equal fairness with other staff members.

Special projects when needed and other duties as assigned.

Job Type: Full-time

Pay: $41,600.00 - $70,000.00 per year

Benefits:

401(k)
401(k) matching
Dental insurance
Flexible spending account
Health insurance
Life insurance
Paid time off
Parental leave
Vision insurance

Application Question(s):

This position is full-time and requires regular, in person attendance at our Ann Arbor, MI office. Please confirm your current location. Only candidates in close geographical proximity to Ann Arbor will be eligible for consideration.

Experience:

Prior Authorization: 2 years (Required)

License/Certification:

Pharmacy Technician License (Required)

Work Location: In person

Quick Apply

Refine Your Search

prior authorization specialist jobs in novi, mi

Prior Authorization Specialist

Pharmacy Benefits Specialist - Mail Order Services - Full Time Days - Rochester Hills

Medical Scribe

Infusion Prior Authorization Specialist

Authorization Specialist

Prior Authorization and Case Management Specialist

Prior Authorization Certified Pharmacy Technician

Financial Clearance Specialist II

Referral Specialist

Pharmacy Benefits Specialist - Specialty - Full Time Days - Rochester Hills

Insurance Specialist/Receptionist

Corporate Medical Billing Specialist

Executive Assistant, Human Resources

Pharmacy Billing Specialist III - On-Site

Front Office Coordinator - Livonia, MI

Front Desk Coordinator/Medical Receptionist

Patient Care Coordinator

Front Office Coordinator - Dearborn Heights, MI

Front Office Coordinator - Ferndale, MI

Patient Visit Specialist I

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