- Penn Medicine (Sellersville, PA)
- …and designees. * Provides required clinical and demographic information to payer to obtain precertification and assure reimbursement. * Communicates with patients ... to obtain complete, accurate, timely clinical and financial information required for payer reimbursement. * Sends all information required to insurance companies to… more
- CVS Health (Blue Bell, PA)
- …sound reserving, forecasting, trend analytics and analysis of regulatory changes and payer contracts that produce returns to shareholders commensurate with the risks ... timely and accurate deliverables. Works cross-functionally with other constituents on payer analytics and segment performance. Applies rigorous financial and value… more
- Adecco US, Inc. (Philadelphia, PA)
- …and appeals, ensuring timely patient access. 3. Design and deliver advanced payer insights tailored to provider needs, incorporating evolving policy trends and ... 7. Serve as a subject matter expert on Medicare and commercial payer structures, translating complex benefit data into actionable insights for stakeholders. 8.… more
- Trinity Health (Newtown, PA)
- …be billed (ie worker's compensation, motor vehicle accidents and any other applicable payer ). + Financial Advocacy: Screens all patients self-pay & out of network ... variants in protocols + Strong knowledge of third-party and government payer billing and reimbursement guidelines as well as department performance standards… more
- Select Medical (Center City, PA)
- …an ICU or post-surgical stay by utilizing your strong clinical background, payer knowledge and problem-solving skills. + Perform clinical assessments of referred ... physicians to create a smooth pre-admissions and transfer processes through removing payer -related and operational barriers for the patients getting into our highly… more
- CSL Behring (King Of Prussia, PA)
- …with Sales, Healthcare Systems, Pricing and Contracting, Insights and Analytics, Payer Marketing, and Medical Affairs, the Director ensures that strategies are ... with Sales, Healthcare Systems, Pricing and Contracting, Insights and Analytics, Payer Marketing, and Medical Affairs, ensures that brand strategies are robust,… more
- CVS Health (Harrisburg, PA)
- …of ensuring coding is accurate and compliant with federal regulations, payer policies, and organizational guidelines. - Working experience with Microsoft Excel. ... - Strong attention to detail and ability to review and interpret data. **Preferred Qualifications** - 2 years or more previous experience with medical record review within a healthcare insurance company. - Prior special investigation unit experience. -… more
- Geisinger (Danville, PA)
- …the referrals for physician offices in compliance with third party payer referral guidelines and requirements Provides one-call resolution whenever possible ... Responsible to address patient and referring physician needs pertaining to insurance coverage and benefit eligibility inquiries and appointments. + Reviews outstanding balances and pre-service patient liability with patients. + Refers patient for Financial… more
- Baylor Scott & White Health (Harrisburg, PA)
- …maintenance. * Prepares the 5-year financial operating forecast to include statistics, payer mix, payments capital, etc. * Prepares examination and presents and ... justifies findings, for any potential capital acquisitions, projects, new services, etc. * Provides ongoing budget vs. actual revenue and expense variance analysis. Reviews both standard and custom reports developed for the entity. * Prepares verbal or written… more
- CVS Health (Harrisburg, PA)
- …leading complex initiatives within the healthcare industry, preferably within the payer space + 5+ years successful experience in strategy, innovation and/or ... business process redesign within the healthcare industry (or equivalent) + Strong interpersonal and verbal/written communication skills, with a proven ability to effectively communicate key messages and deliver presentations across all levels of the… more