- WellSpan Health (York, PA)
- …including, but not limited to answering inquiries and researching third party payer policies and coding guidelines to optimize reimbursement for the system while ... departments, including Compliance to initiate steps for resolution. + Investigates payer denials and institutes appropriate courses of action. + Prepares detailed… more
- UPMC (Pittsburgh, PA)
- …and treatments. The employee uses their knowledge of acute care experience and payer regulations to assess medical necessity and ensure the presences of supporting ... state. + 5 years of acute care clinical experience. + 2 years payer or care management experience. + Understanding of clinical and care management process.… more
- Cardinal Health (Harrisburg, PA)
- …need for a better quality of life. Our diverse expertise in pharma, payer and hub services allows us to deliver best-in-class solutions-driving brand and patient ... a timely manner + Mediate effective resolution for complex payer /pharmacy issues toward a positive outcome to de-escalate +...appropriate sections of the database + Must track any payer /plan issues and report any changes, updates, or trends… more
- Community Health Systems (Kingston, PA)
- …Submits and processes claims accurately and efficiently, ensuring compliance with payer requirements and company policies. + Communicates with insurance companies, ... corrective actions. + Reviews and corrects claim filing edits based on payer requirements and electronic health record (EHR) system alerts. + Maintains accurate… more
- Guidehouse (Philadelphia, PA)
- …collaborative changemaker with a proven track record in healthcare payer /provider consulting. You bring advanced expertise in strategy, project leadership, ... goals. + Develop and implement comprehensive strategies for healthcare payer /provider clients, including business model transformation, operating model design,… more
- Robert Half Office Team (Latrobe, PA)
- …authorizations, referrals, and certifications to meet medical necessity guidelines and payer regulations. * Respond promptly to patient and departmental inquiries, ... with departmental policies, procedures, and system updates, including insurance payer regulations. * Display respect and professionalism in all interactions… more
- Guthrie (Sayre, PA)
- …and answering questions. Responsibilities: Confirms insurance coverage via payer portals and determines necessity for pre-authorization. Obtains authorization ... timeframes and assuring referrals are maintained within appropriate network and/or payer requirement. Remains current on referral policies and procedures, payer… more
- PSKW LLC dba ConnectiveRx LLC (Pittsburgh, PA)
- …Identify potential mechanisms for quick access to therapy by recognizing any payer coverage restrictions. + Showcase your ability to contribute effectively, whether ... in accordance with federal and state regulations. + Accurately document payer Prior Authorization and Appeals protocols, ensuring meticulous attention to detail.… more
- Penn Medicine (East Petersburg, PA)
- …management guidelines + Review and resolve charges in work queues based on payer edits, CCI edits, and coding-related denials + Collaborate with customer service ... considered secondary to the primary duties listed above: + Monitors payer guidelines to ensure accurate coding, including local Medicare Administrative Contractor… more
- ZOLL Medical Corporation (Pittsburgh, PA)
- …Functions + Obtains necessary documentation for continued use as dictated by payer , including new medical order, updated clinical information or forms. + Contacts ... + Review submitted medical orders for completeness and accuracy according to payer standards. + Performs other duties as assigned by Management. Required/Preferred… more