Prior Authorization Guideline Specialist

Summary

A healthcare professional reviews patient records and insurance policies to determine if prescribed treatments meet prior authorization requirements before approval.

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Nexus Recruitment Group

5 days ago

Prior Authorization Guideline Specialist

APACFull-time

Develops and maintains pharmacy prior authorization guidelines for Medicaid pharmacy operations, coordinating with clinical teams to ensure accurate documentation and compliance in a hybrid role based in the Philippines.

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Nexus Recruitment Group

5 days ago

Clinical Documentation Specialist

RemoteAPACFull-time

Reviews and improves healthcare documentation to ensure accurate billing, coding, and regulatory compliance, collaborating with providers and coders.

US Digestive Health

6 days ago

Prior Authorization Specialist

Open 15d Us

Processes insurance authorizations for prescribed medications by verifying patient coverage, researching clinical details, and communicating approvals/denials to patients and providers in a healthcare office setting.

Nexus Recruitment Group

5 days ago

In-Patient Coding Quality Assurance Specialist

RemoteAPACFull-time

A healthcare coding specialist reviews inpatient medical records to audit coding accuracy, ensure compliance with ICD-10-CM/PCS and payer rules, and train teams on best practices.

House Rx

6 days ago

Prior Authorization Supervisor

Open 17d On-siteNorth America

Supervises a team of prior authorization specialists in a specialty pharmacy, ensuring efficient approvals for complex medications while coaching staff and improving workflows.

Unknown company

6 days ago

Insurance Prior Authorization Representative

North AmericaFull-time

Processes insurance prior authorization requests for medical equipment by reviewing clinical documents and verifying compliance with insurance guidelines in a healthcare-focused team.