- Humana (Austin, TX)
- …performance improvement, physician engagement, informatics, network development, and contract/ payer relations. This design gives the Fellow the opportunity ... to build fundamental communication, analytic, and problem-solving skills as well as an understanding of the ACO environment and population health strategies. To complement on-the-job training, fellows are involved in Board and other administrative meetings.… more
- Highmark Health (Austin, TX)
- …both the return on investment (ROI) and other decisions on the payer partnership constructs. These new approaches require new operational capabilities, and this ... team is responsible for identifying those gaps, building requirements to drive the development of new capabilities, and tying them to Highmark's strategic capability roadmap. They will need to work effectively across teams to inform and influence change to… more
- HCA Healthcare (Conroe, TX)
- …established chain of command. + Makes appropriate referrals to third party payer and disease and case management programs for recurring patients and patients with ... chronic disease states. + Facilitates patient throughput with an ongoing focus on an effective care transition, quality, and efficiency. + Documents professional recommendations, discharge plan, care coordination interventions, and case management… more
- Methodist Health System (Dallas, TX)
- …Job Responsibilities: * Accurately post and allocate all payments per vendor or payer details to patient accounts. * Ensures accuracy of cash application by ... balancing deposit totals to system-generated reports. * Accurately post all details per explanation of benefits for manually posted remits. * Adhere to all departmental deadlines for posting payments. * Work closely with various parties (patients, insurance… more
- Houston Methodist (Katy, TX)
- …Billers, as necessary, to obtain additional information/clarification. + Informs manager of payer trends or any problems or changes in payor requirements, including ... any barriers or obstacles. **QUALITY/SAFETY ESSENTIAL FUNCTIONS** + Obtains corrected information and requests rebills as needed. + Provides clear and concise documentation of every action taken on an account in the system collection notes. Provides balance… more
- STG International (Temple, TX)
- …7. Handle all correspondence timely following policy and procedures 8. Verify accurate payer data on all accounts 9. Perform duties to ensure timely conversion to ... Medicaid 10. Immediately communicate correspondence from fiscal intermediaries and others 11. Communicate and work cooperatively with vendors supplies and contractors 12. Ensure timely deposits 13. Monitor bad debt level, avoid significant increase 14.… more
- R1 RCM (TX)
- …client contract language and rates to resolve denied claims. + Utilize payer -provider and administrative manuals to dispute denied claims. + Contact provider ... representatives or higher-level resolution units to resolve complex claim and appeal issues. + Represent clients during Administrative Law Judge hearings as needed. + Assist with the training of recovery staff team members and provide necessary feedback as… more
- Datavant (Austin, TX)
- …and educational needs related to coding quality, compliance assessments, external payer reviews, coding education, and coding workflow operations reviews. In this ... role, you will offer meaningful information tailored to exceed customer expectations, actively identifying and presenting solutions for customer issues. This role is fully remote with a flexible schedule, allowing you to help shape the future of healthcare… more
- Lundbeck (Waco, TX)
- …to stay informed on reimbursement dynamics, anticipate and effectively address payer access issues (IDNs, Medicare, Medicaid, Commercial) using Lundbeck resources. ... **Pharmaceutical Environment/Compliance** - Apply knowledge of pharmaceutical and regulatory environment, including accountability and adherence to Lundbeck policies and procedures and FDA regulations regarding the promotion of pharmaceutical and medical… more
- Kyndryl (Austin, TX)
- …+ Healthcare industry experience is a strong plus, especially in payer /provider operations and care management workflows. **Preferred Qualifications: ** + 15+ ... years' experience in contact center sales, consulting, services, or transformation initiatives. + Previous experience in leading healthcare-focused journey redesign from eligibility verification to care management. + Align contact center transformation with… more