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Prior authorization Remote Jobs

59 fresh jobs found

Field Reimbursement Manager - North Central
Columbus, Ohio; Cleveland, Ohio; Indianapolis, Indiana; Detroit, Michigan; Grand Rapids, Michigan; Des Moines, Iowa; Chicago, Illinois; Minneapolis, Minnesota; St. Paul, Minnesota; Milwaukee, Wisconsin

HeartFlow, Inc.

Claims Appeals Educational material development Healthcare innovation Customer Education Medical Billing Prior authorization Medical Technology Medical Records Commercial +24

USD 84K+

Supervisor, Access Patient and Support
US-Nationwide-FIELD, United States

Cardinal Health Remote-first

HR responsibilities Remote Team Leadership Program metrics Benefit investigations Pay equity IT solutions Prior authorization Standard Operating Procedures Enrollment +28

USD 66K+

Care Manager – Patient Support Call Center - - -Remote
Northborough, Massachusetts, United States of America

Telephony platform Iqvia Telephony Insurance Verification Analytic Prior authorization Medical Billing Patient Support Patient services +35

USD 44K+

Field Reimbursement Specialist
USA - MD - Remote, United States

AmerisourceBergen

Patient assistance Buy and bill Coverage management Formulary Specialty distribution Educational presentations Benefit investigations Pharmacy benefits Health policy +29

USD 86K+

Senior Field Reimbursement Manager - Upper Midwest Region
US - IL - offsite, Estados Unidos

Gilead Sciences

Reimbursement processes Billing and Coding Therapies Provider Relations Prior authorization Patient Support Patient Access Vision Claims processing +23

Senior Full Time

USD 143K+

Prior Authorization Pharmacy Technician - Remote
Any city, OR, US, 99999

Gainwell Technologies

Provider Prior authorizations Pharmacy Technician Call center Operations Pharmacy benefit management Prior authorization Processes Cross-functional Teams HIPAA Compliance +28

USD 35K+

Utilization Review Clinician - Behavioral Health
Remote-FL, United States

Centene Corporation

Medical appropriateness Concurrent review Healthcare Collaboration Treatment plans Clinical Review Utilization Guidelines Health Services Medical management +23

USD 52K+

Utilization Management - Behavioral Health Professional
Work at Home - Louisiana, United States

Interpreting Criteria Advanced Computer Electronic Information Applications MCG Social service agencies Health promotion Medical Services Bilingual English/Spanish HireVue +55

USD 65K+

Field Reimbursement Manager (FRM), - Pulmonary & Gastroenterology - Toledo, OH
Remote, US, United States

Pulmonology Alternative funding options Access Issue Resolution Payer landscape Gastroenterology Reimbursement support Financial assistance Patient Support Services Appeals +28

Senior Mid Full Time

USD 122K+

Utilization Review Clinician - Behavioral Health (Sat-Wed Shift)
Remote-FL, United States

Centene Corporation

Medical appropriateness Concurrent review Healthcare Collaboration Treatment plans Clinical Review Utilization Guidelines Health Services Medical management +23

USD 52K+

Supervisor, Access and Patient Support
US-Nationwide-FIELD, United States

Cardinal Health Remote-first

Program metrics Benefit investigations Remote team management Metrics Reporting Pay equity Workflow Prior authorization Standard Operating Procedures Workflow Management +27

USD 65K+

Revenue Cycle Claims Specialist-Temp
Remote

Modifier selection Payer utilization management UB revenue codes Procedure coding Insurance collections Billing and Coding Billing Systems Appeals Cell-free DNA +36

USD 46K+

Revenue Cycle Claims Client Billing Specialist-Temp
Remote

Modifier selection Payer utilization management UB revenue codes Procedure coding Insurance collections Billing and Coding Billing Systems Appeals Cell-free DNA +36

USD 42K+

Clinical Account Manager - MN RDUR - Remote
Home, United States

Prime Therapeutics

Patient Care Enhancement Clinical Account Management Cost Solutions Pharmaceutical care Contract Compliance Prior authorization P&L Management Utilization management Talent Management +26

USD 108K+

Bilingual Clinical Pharmacist (Spanish/English)
Remote

Formulary Compliance Drug Utilization Review Clinical policy development PBM Pharmacy operations Clinical pharmacy Prior authorization Healthcare experience Medication management +10

USD 125K+

Bilingual Pharmacy Technician, Navigation (Spanish/English)
Remote

Pharmacy Claims Adjudication Benefit design PBM Pharmacy Technician Claims Adjudication Administrative Tasks Prior authorization Healthcare experience Specialty Pharmacy +8

Entry Mid Full Time

USD 42K+

Primary Care Medication Access Pharmacist Manager
Supply Chain Center, United States

Intermountain Health

Pharmacy Practice Prior authorization Medication management Quality improvement Typing People Management Financial Management Accountability Pharmacy +15

Senior Mid Full Time

USD 124K+

Part Time-Associate Medical Director(Required Weekends)
Dayton WFH, United States

Prior authorization reviews Clinical appeals support Clinical case review Medical consultation Performance evaluations Systematic Thinking Clinical appeals URAC Data Sharing +31

Senior Mid Part Time

USD 191K+

Case Manager, Patient Services (West Coast Candidates)
Remote (United States), United States

PTC Therapeutics, Inc.

Peer-to-peer review Pharmacy billing Appeals Prior authorization Patient Engagement Patient services Active Listening Data Entry Quality +10

USD 81K+

Coordinator, Grievance and Appeals
United States

Navitus Health Solutions, LLC

Grievance handling Appeals management Grievance and appeals Medical Director HIPAA regulations Pharmacy Claims Prior authorization CMS Health +15

USD 46K+

Regional Account Manager, Market Access
US Remote

Managed care contracting Qlik HIPAA/PHI Privacy PHI Privacy PHI Legal counsel Policies and procedures Cell-free DNA Diagnostic Testing +37

USD 107K+

Senior Manager of Financial Clearance
Remote - North Carolina, United States

Pre-service collections Financial Clearance Operational Oversight Financial counseling Athena EHR systems Insurance Verification Prior authorization Value-based care +19

Senior Full Time

USD 95K+

Pharmaceutical Sales Representative - GREEN BAY, WI
Remote-Sales, United States

Otsuka Pharmaceutical Companies

Ecosystem approach Digital-Enabled Support Healthcare Provider Interaction Healthcare ecosystem Health Science Patient experience Healthcare Environment Impactful Communication Pharmaceutical Development +35

Senior Mid Full Time

USD 104K+

Sr. Product Manager - Client Group
Remote

Virta Health Remote-first

Consumer-Facing Applications Fhir standards Personalized Nutrition Health plans Data services FHIR Prior authorization Dashboard Creation Workflow Optimization +21

Senior Full Time

USD 170K+

Remote Medical Director, Grievances & Appeals
Dayton WFH, United States

Clinical case review Medical consultation Performance evaluations Clinical appeals Systematic Thinking URAC Cultural Sensitivity Data Sharing Critical Listening +31

Exec Senior Full Time

USD 191K+

Sr Manager, Provider Data Operations Implementation (Implementation experience a must)
Dayton WFH, United States

Provider data management Contract administration Provider Relations Healthcare Regulations Prior authorization Healthcare administration Project Planning Credentialing Enrollment +50

Senior Full Time

USD 92K+

Pharmaceutical Sales Representative - Columbus SW, OH
Remote-Sales, United States

Otsuka Pharmaceutical Companies

Ecosystem approach Digital-Enabled Support Healthcare Provider Interaction Healthcare ecosystem Health Science Healthcare Environment Patient experience Impactful Communication Pharmaceutical Development +35

Senior Mid Full Time

USD 104K+

Field Reimbursement Manager, Allergy-ENT - Louisville North
Remote, US, United States

Allergy Alternative funding options Access Issue Resolution Payer landscape Reimbursement support Financial assistance Patient Support Services Appeals Prior authorization +26

USD 122K+

Client Services Analyst I, Remote, USA
Any city, TX, US, 99999

Gainwell Technologies

Member eligibility Provider Referral management CMS guidelines Medical claims Data reconciliation Microsoft Visio Accuracy Prior authorization +36

Entry Mid Full Time

USD 50K+

Process Improvement Analyst Principal - Remote
Home, United States

Prime Therapeutics

Minitab Cognos Kaizen Pharmacy benefit management Healthcare Industry Knowledge Lean Six Sigma Process Management Prior authorization PowerBi +38

Senior Full Time

USD 94K+

Senior Reimbursement Specialist - Prior Authorization
Remote, N/A, United States

Guardant Health

Merchant solutions Payer engagement Edi enrollment Laboratory billing Billing operations Xifin Payer Portals Healthcare Billing Insurance Claims +24

Senior Full Time

USD 48K+

Analyst, UM
United States

Navitus Health Solutions, LLC

System Configuration Prior authorization Workflow Management Utilization management Business Processes CMS Health Health care Pharmacy +16

Entry Mid Full Time

USD 49K+

Reimbursement Specialist II - Prior Authorization (9:00 AM - 5:30 PM CST, Monday - Friday Shift)
Remote, OR, United States

Guardant Health

Merchant solutions Appeals processes Commercial payer policies Laboratory billing workflows Revenue cycle tools Payer Communication Edi enrollment Insurance Coordination Conditional logic +25

Entry Mid Full Time

USD 44K+

Field Reimbursement Manager- Rare Blood Disorders, Patient Support Services, Midwest
Remote, US, United States

Access Issue Resolution Alternative funding options Reimbursement Management Payer landscape Billing and Coding Financial assistance Patient Support Services Patient Support Programs Regulatory Guidelines +37

USD 122K+

Clinical Systems Application Architect III
Dayton WFH, United States

Aerial medecision 275/278 Interoperability techniques Healthedge Clinical IT Care management packages 278 ADT Server technologies +80

Senior Full Time

USD 110K+

Lead Actuarial Analyst
United States

Cohere Health Remote-first

Cost savings analysis ROI Reporting Data Analysis Tools Actuarial modeling Clinical Strategy Strategic recommendations Cost Containment Strategic Insights Model Development +34

Senior Full Time

USD 135K+

Senior Manager, Data Science
United States

Cohere Health Remote-first

Analytical frameworks Pattern Recognition Clinical Intelligence Classification Prior authorization Performance Tracking Data Mining Healthcare industry Digital Health +25

Senior Full Time

USD 170K+

Weekend RN Reviewer
United States

Cohere Health Remote-first

Healthcare Programs Retrospective review Concurrent review Accreditation Compliance Strategic operations Quality Metrics Clinical Review Clinical Intelligence Medical necessity +24

USD 66K+

Senior Data Scientist
United States

Cohere Health Remote-first

Causal Analysis Spark SQL Trend Identification Clinical programs Algorithm Development Clinical Intelligence Kibana Healthcare Analytics Cloud platform +33

Senior Full Time

USD 120K+

RN Reviewer
United States

Cohere Health Remote-first

MCG Care Guidelines Healthcare Programs Strategic operations Quality Metrics Clinical Review Clinical Intelligence Medical necessity Acute care Prior authorization +23

USD 70K+

Utilization Review/Appeals Clinician - ABA
Remote-FL, United States

Centene Corporation

ABA services Autism spectrum disorder Medical appropriateness Clinical Standards Applied Behavioral Analysis Behavioral Analysis Healthcare Provider Interaction Applied Behavior Analysis Treatment plans +28

USD 52K+

Patient Experience Liaison-Illinois-Michigan
Remote, United States

Otsuka Pharmaceutical Companies

Benefit verification Medication Access Treatment access Healthcare Landscape Medical claims Strategic Mindset Patient experience Insurance coverage Healthcare Environment +32

USD 117K+

Patient Experience Liaison - Michigan
Remote, United States

Otsuka Pharmaceutical Companies

Benefit verification Treatment access Healthcare Landscape Pharmacy Claims Medical claims Strategic Mindset Patient experience Insurance coverage Healthcare Environment +31

USD 117K+

Patient Experience Liaison - Cleveland
Remote, United States

Otsuka Pharmaceutical Companies

Benefit verification Treatment access Healthcare Landscape Pharmacy Claims Patient experience Insurance coverage Healthcare Environment Impactful Communication Health Science +29

USD 117K+

Claims Clinical Documentation Reviewer
REMOTE OPTIONS, PHOENIX

State of Arizona

Healthcare laws Prepayment claims review Medical necessity evaluation Audit reporting Service planning Claims review Medicaid programs Stakeholder Coordination Documentation Review +61

USD 68K+

Billing Strategy Lead, Prior Authorizations
US Remote

Prior authorization operations Prior authorizations PHI Privacy HIPAA/PHI Privacy PHI Business Intelligence Tools Women's Health Security Training Healthcare Billing +45

Senior Mid Full Time

USD 90K+

Billing Strategy Lead, Patient Billing
US Remote

Patient billing operations PHI Privacy HIPAA/PHI Privacy PHI Business Intelligence Tools Women's Health Security Training Healthcare Billing Cell-free DNA +60

Senior Mid Full Time

USD 90K+

Vice President, Children's Health-Care Management
Remote-FL, United States

Centene Corporation

Health outcomes initiatives Medicaid compliance Population health strategy Executive leadership Provider contracts UM Quality Initiatives Compliance requirements Clinical programs +57

Exec Senior Full Time

USD 182K+

Field Reimbursement Specialist
USA - IL - Remote, United States

AmerisourceBergen

Coverage management Formulary Specialty distribution Buy and bill Benefit investigations Pharmacy benefits Educational presentations Patient assistance Reimbursement support +30

USD 86K+

Analyst, PA Accel
United States

Navitus Health Solutions, LLC

NCPDP PBM knowledge Benefit configuration Business Judgment System testing Pharmacy benefit management Prior authorization Health Root Cause Analysis +12

Entry Mid Full Time

USD 55K+

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