- CVS Health (Harrisburg, PA)
- …DME, and helps to ensure timely physician follow-up. - Understands Payer /Plan benefits, policies, procedures, and can articulate them effectively to providers, ... members, and other key personnel. Our TOC Coaches are frontline advocates for members who cannot advocate for themselves. The TOC team will review prior claims to address potential impact on current case management and eligibility status. Focus assessments… more
- Select Medical (Camp Hill, PA)
- …+ Cash/Banking reporting and reconciliation (Healthcare) + Projection reporting + Payer audits + Process enhancements + Department projects and research + ... Vendor/Developer collaboration **Qualifications** **REQUIREMENTS** + High School Diploma or equivalent + Excellent analytical problem-solving skills + Excellent computer skills and Excel proficiency + Excellent communication skills **PREFERRED QUALIFICATIONS**… more
- J&J Family of Companies (Horsham, PA)
- …strategies into tactics. + Build and execute thoughtful training plan for payer and institutional account teams, ensuring improved proficiencies and preparedness for ... market events. Lead any necessary National Meetings / Fast Start Meetings for SCG and contribute to other field organization training needs related to access & fulfillment. + Identify and drive SCG-relevant requirements across the Integrated Evidence Team… more
- Penn Medicine (Bala Cynwyd, PA)
- …preferred + 2+ years Home care experience with knowledge of home health regulations and payer mix We believe that the best care for our patients starts with the best ... care for our employees. Our employee benefits programs help our employees get healthy and stay healthy. We offer a comprehensive compensation and benefits program that includes one of the finest prepaid tuition assistance programs in the region. Penn Medicine… more
- Trinity Health (Newtown, PA)
- …(ie worker's compensation, motor vehicle accidents and any other applicable payer ). + Maintains operational knowledge of regulatory requirements and guidelines as ... outlined in the hospital and department Compliance Plans. + Informs and explains all applicable government and private funding programs and other cash payment plans or discounts to the patient and/or family. **Qualifications:** + HS diploma or equivalency… more
- Cognizant (Harrisburg, PA)
- …for timely and accurate adjudication of professional and hospital claims utilizing payer specific policies and procedures. Provide support to claims and client for ... issues related to claims adjudication and adjustments. You will be a valued member of the Cognizant team and work collaboratively with stakeholders and other teams. **In this role, you will:** * Be Responsible for reviewing the data in the claim processing… more
- Centene Corporation (Harrisburg, PA)
- …management activities to ensure compliance with current state, federal, and third-party payer regulators + Provides and/or facilitates education to members and their ... families/caregivers on disease processes, resolving care gaps, healthcare provider instructions, care options, referrals, and healthcare benefits + Provides feedback to leadership on opportunities to improve and enhance care and quality delivery for members in… more
- UPMC (Pittsburgh, PA)
- …co-morbidities have been coded in compliance with coding guidelines, third-party payer and OIG regulations. **Responsibilities:** + Focus emphasis of educational ... presentations on accurate and thorough documentation necessary to support the coding of diagnoses that were treated, monitored and evaluated and procedures that were performed during an episode of care. + Review and evaluate focused UPMC DRG medical records… more
- UPMC (Pittsburgh, PA)
- …of reimbursement systems, the ability to educate patients and families regarding payer requirements / coverage for post-acute care services and the ability to ... effectively advocate on behalf of the patient. + Continue to monitor and evaluate the plan of care, options and available services throughout the hospital stay to effectively meet the patient and family's need. Reassess the plan of care as status changes or at… more
- Select Medical (Philadelphia, PA)
- …business development team + Collect co-pays from patients, manage payer approvals, and conduct insurance authorizations and verifications **Qualifications** ... **Minimum:** + High School Diploma or GED **Preferred:** + 1 Year Front Desk experience + Healthcare experience + 3+ years of OP experience **Additional Data** _Equal Opportunity Employer/including Disabled/Veterans_ Apply for this job… more