- Cardinal Health (Columbus, OH)
- …the appropriate system. + Manages and resolves complex insurance claims, including appeals and denials, to ensure timely and accurate reimbursement. + Processes ... regulations, or third party policy. + Updates patient files for insurance information, Medicare status, and other changes as necessary or required. + Keeps email… more
- Cleveland Clinic (Beachwood, OH)
- …thorough benefits investigation and processes any necessary prior authorizations and/or appeals for pharmacy claims. + Explain benefit coverage and financial ... the patients. + Resolve aspects of specialty pharmacy insurances, including Medicare , Medicaid, Pharmacy Benefit Managers (PBM), and Preferred Provider Organizations… more
- Elevance Health (Mason, OH)
- …weekly clinical prior authorizations and coverage determinations for Medicaid and Medicare . + Participate in the pharmaceutical care management process through ... resolve issues related to member/provider complaints, claims processing issues and appeals . **Minimum requirements:** + PharmD from an accredited school of pharmacy… more
- Baylor Scott & White Health (Columbus, OH)
- …leadership, and senior medical staff including denials from all payers, Medicare /Medicaid audit activities and key contract enforcement activities. + Collaborates ... (CBS) and other revenue cycle departments to streamline referral and appeals workflows. + Supports education and training initiatives to improve documentation… more