The reviewer will perform medical necessity utilization management and care coordination to ensure members receive appropriate, evidence-based behavioral health services. They will collaborate with interdisciplinary teams and providers to facilitate transitions of care and support positive clinical outcomes.
Review, investigate, adjust, and finalize medical claims accurately and on time, resolving discrepancies with adjudication partners and vendors. Meet quality and productivity goals, respond to claims inquiries, identify processing issues, collaborate across teams, and protect confidential information while following regulatory requirements.
The Prior Authorization Specialist processes referrals and authorizations for specialty services while collaborating with clinical teams and insurance providers. They also manage denial reports, maintain accurate medical records, and provide support to patients and staff regarding authorization status.
The Prior Authorization Specialist processes referrals and authorizations for specialty services while collaborating with clinical teams and insurance providers. They also manage denial reports, maintain accurate patient records, and provide guidance to internal and external customers regarding authorization processes.
The Prior Authorization Specialist processes referrals and authorizations for specialty services while ensuring accurate documentation and timely communication with providers and patients. They also manage denial reports, handle appeals, and serve as a resource for internal and external stakeholders regarding authorization requirements.
The analyst will support sponsored research financial operations by managing award setups, invoicing, and account reconciliations. They will also prepare financial reports and dashboards while ensuring compliance with sponsor regulations and institutional policies.
