- Teva Pharmaceuticals (Pittsburgh, PA)
- …and coach others on regional business focus areas, including settings of care, payer and pull through opportunities, and flawless execution of the marketing strategy ... and coach others on regional business focus areas, including settings of care, payer and pull through opportunities, and flawless execution of the marketing strategy… more
- Highmark Health (Monroeville, PA)
- …Documents, monitors, intervenes/resolves and reports clinical denials/appeals and retrospective payer audit denials. Collaboratively formulates plans of action for ... to all AHN staff regarding utilization review practice and governmental commercial payer guidelines. Adheres to the policies, procedures, rules, regulations and laws… more
- Merck (Harrisburg, PA)
- …targeting and business analysis. + Articulates the complexities of the HIV payer environment, recognizing the role each stakeholder plays in the ability to ... and build partnerships with key stakeholders/departments. + Experience with complex payer environments, recognizing the role each stakeholder plays in the ability… more
- Datavant (Harrisburg, PA)
- …to noisy or incomplete inputs. You'll own the Matching roadmap for our Payer vertical, while also shaping the broader strategy and uncovering needs across other ... + Familiarity with healthcare data, with bonus points for experience in the payer risk adjustment space + Deep comfort working with engineering and analytics teams… more
- UPMC (Washington, PA)
- …+ Verify accuracy of payment posting and reimbursement. Work with appropriate payer and/or department to resolve any payment discrepancies. + Identify root cause ... and medical terminology is preferred. + Familiarity with third party payer guidelines and reimbursement practices and available financial resources for payment… more
- Organon & Co. (Plymouth Meeting, PA)
- …in complex markets within complex systems required. + Strong understanding of Payer environment, reimbursement and challenges within National, Regional and local ... payer market including: government programs, managed health care and evolving health care systems. + Proven ability and success in developing physician and key… more
- Guthrie (Troy, PA)
- …an acute care setting with strong care management, utilization review, and payer knowledge. A Case Management certification or obtaining a Case Management ... point for communication for healthcare team members, patient, provider, and payer . b) Supports development, integration, and monitoring. c) Maintains accountability… more
- Penn Medicine (Philadelphia, PA)
- …staff and designees. Provide required clinical and demographic information to payer to obtain precertification and assure reimbursement. Communicate with patients to ... obtain complete, accurate, timely clinical and financial information required for payer reimbursement. Fax all information required to insurance companies to… more
- Penn Medicine (Philadelphia, PA)
- …+ Responsible for rejections, edits, and accounts receivable for specific payer group(s) work queues as assigned. + Initiates and coordinates follow-up ... acceptable collection rates and days in A/R for each type of insurance payer assigned. * Demonstrates success in completing target level or above averaged number… more
- Penn Medicine (Philadelphia, PA)
- …accurate and timely clinical and financial information required for payer reimbursement.Asses clinical information for appropriateness of settling and utilization ... and cost effective.Provide required clinical and demographically information to payer to obtain pre-certification and assure reimbursement.Identify potential quality… more