- Cardinal Health (Columbus, OH)
- …+ Must follow through on all benefit investigation rejections, including Prior Authorizations, Appeals , etc. All avenues to obtain coverage for the product must be ... documenting patient health insurance benefit investigations, prior authorizations, and appeals , preferred + Cell/Gene therapy and/or Oncology experience, preferred +… more
- Evolent (Columbus, OH)
- …of the request and provides clinical rationale for standard and expedited appeals . + Utilizes medical/clinical review guidelines and parameters to assure consistency ... by any state or federal health care program, including Medicare or Medicaid, and is not identified as an...General Service Administration (GSA), or reprimanded or sanctioned by Medicare . + No history of a major disciplinary or… more
- Evolent (Columbus, OH)
- …of the request and provides clinical rationale for standard and expedited appeals . . Utilizes medical/clinical review guidelines and parameters to assure consistency ... by any state or federal health care program, including Medicare or Medicaid, and is not identified as an...General Service Administration (GSA), or reprimanded or sanctioned by Medicare . . No history of disciplinary or legal action… more
- Evolent (Columbus, OH)
- …subject matter expert. + Provides clinical rationale for standard and expedited appeals . + Discusses determinations (peer to peer phone calls) with requesting ... by any state or federal health care program, including Medicare or Medicaid, and is not identified as an...General Service Administration (GSA), or reprimanded or sanctioned by Medicare . + No history of a major disciplinary or… more
- Cardinal Health (Columbus, OH)
- …insurance plan coverage, including out-of-pocket costs, and provide guidance on the appeals process if needed + Resolve patient's questions and any representative ... about long and short-range changes in the reimbursement environment including Medicare , Medicaid, Managed Care, and Commercial medical and pharmacy plans while… more
- Adecco US, Inc. (Columbus, OH)
- …fast-paced role that demands a strong understanding of medical reimbursement, Medicare and commercial payers, and buy-and-bill or specialty pharmacy distribution ... Support (20%)** - Assist offices with claims, billing and coding, appeals , medical benefit interpretation, and co-pay or patient assistance programs. Coordinate… more
- Evolent (Columbus, OH)
- …of best practices. + Provides clinical rationale for standard and expedited appeals . + Discusses determinations (peer to peer phone calls) with requesting physicians ... by any state or federal health care program, including Medicare or Medicaid, and is not identified as an...General Service Administration (GSA), or reprimanded or sanctioned by Medicare . + No history of a major disciplinary or… more
- Adecco US, Inc. (Columbus, OH)
- …with Benefit Investigations, Prior Authorizations, Claims Assistance, and Appeals . + Deliver reimbursement support, account management, billing/coding updates, ... 8 years of healthcare-related reimbursement experience. + Strong knowledge of Medicare and commercial insurance coverage, benefit structures, and prior authorization… more
- Elevance Health (Mason, OH)
- …authorization requests from physicians offices and ensures compliance with Medicare requirements; informs relevant parties of all prior authorization determinations. ... + Provides resolution to grievances and appeals issues. + Responds to inquiries from physicians, sales team, and members related to formulary and prescription… more
- Insight Global (Cleveland, OH)
- …Prior Authorization/Gold Carding, Eligibility/Benefits Verification, Claim Submission, Adjudication, Payment, Appeals /Grievances) ○ Ability to map out a high level ... 3+ years of Managed Care experience with payers like Medicare /Medicaid/Dual Eligibility/D-SNP/Marketplace/Tricare * Fearless and sharp communicator, comfortable jumping… more
Recent Jobs
-
Sr. Construction Superintendent Travelling - Sports/Stadium
- AECOM (Dallas, TX)
-
Maintenance Mechanic PRN
- HCA Healthcare (El Paso, TX)
-
Construction Supervisor, Telecom
- TAK Communications (Butte, MT)
-
Community Health Educator, RN - Part Time Day
- RWJBarnabas Health (Lakewood, NJ)