Prior Authorization Specialist — Healthcare Claims & Appeals
Cumberland Healthcare (Cumberland Memorial Hospital)
Cumberland Healthcare in Maine is seeking a Prior Authorization Specialist to join our team. The role centers on obtaining prior authorizations from insurance companies for healthcare providers and ensuring timely, accurate approvals. This position requires verifying coverage, reviewing medical records, and assessing eligibility. Responsibilities include communicating with insurers, tracking cases, updating patient insurance information, managing work queues and denials, and supporting the #J-18808-Ljbffr Cumberland Healthcare (Cumberland Memorial Hospital)
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$50k
...comprehensive solutions that span the entire healthcare value chain. Formed by the merger of... ...laws and regulations. Demonstrate prior experience working with pharmacy... ...benefit coverage, including any prior authorization, appeal, tier exception, or formulary exclusion...SuggestedTemporary workWork at officeImmediate startMonday to FridayFlexible hoursShift work$65.73k - $81.19k
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- ...Senior Pharmacy PA/Appeals Technician Optum is a global organization... ...include supporting the prior authorization and appeals process by... ...service, customer relations, healthcare, pharmacy, call center, or direct... ...formulary review, pharmacy claims, or healthcare coverage...ClaimsTemporary workRemote workMonday to FridayShift workAfternoon shift
- Job Summary/Duties Cumberland Healthcare is currently searching for a Prior Authorization Specialist to join our team. The primary duty of this team member would be obtaining... ...work queues and denials, and supporting the appeal process. Experience Prior Authorization...Full time
$90 - $118 per hour
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$90k - $120k
...exceptional strides in healthcare innovation, is... ...without authority, and frustrated by... ...denial trend or a prior authorization bottleneck... ...authorization through appeal outcome, and close... ...post-service claims and appeals Partner... ...(Certified Coding Specialist) certification...ClaimsWork experience placementLive inWork at officeLocal areaRemote workWorldwideRelocationRelocation package$18 - $32 per hour
...functions of a Senior Pharmacy PA/Appeals Technician include supporting the prior authorization and appeals process by... ...customer service, customer relations, healthcare, pharmacy, call center, or... ...benefits, formulary review, pharmacy claims, or healthcare coverage...ClaimsHourly payDaily paidMinimum wageFull timeTemporary workPart timeWork experience placementLocal areaRemote workRelocation packageMonday to FridayShift workAfternoon shift$80 per hour
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$133.5k - $274.1k
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...billing, insurance follow‑up, denials and appeals, self‑pay, cash posting, payment... ...HB and PB populations. Monitor aging, claim status, denials, underpayments, payment... ...Requirements: Associate or bachelor's degree in healthcare administration, business, finance, or...ClaimsRemote jobFull timeTemporary workWork at officeMonday to Friday- ...for Medicare Advantage and US Family Health Plan programs, coordinating with Claims, Compliance, and external partners to prevent fraud, waste, and abuse. The role requires 5+ years in healthcare fraud investigation, strong data analysis, and proficiency with CMS formats...Claims
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...drug interactions and offering preventive healthcare services such as immunizations.... ...Ensures the accurate processing of insurance claims to resolve customer issues and prevent payment... ...from an accredited educational institution prior to the start date in position....Hourly payInternshipLocal areaShift work$133.5k - $274.1k
...position is responsible for providing expert medical analysis of claims files (or underwriting applications) across Unum US product... ...intended audience Perform telephone contacts with the insured’s healthcare providers to gather medical information and to facilitate a...ClaimsTemporary workWorldwideFlexible hours- ...Project Execution (claims management, change order... ...or a Business Process Specialist. The location of the... ...and strategy Work Authorization: Legally authorized to... ...educational credentials prior to the program start... ..., transportation, and healthcare. From more resource-efficient...ClaimsRotational programPermanent employmentFull timeContract workInternshipLocal areaRelocationRelocation package
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