- Sanofi Group (Houston, TX)
- …contribute to special projects focused on enhancing Market Access operations (eg, payer onboarding, hub integration, channel expansion) + Maximize digital tools with ... Trade & Channel, or Commercial Operations. + Deep operational knowledge of US payer systems, PBMs, GPOs, and specialty pharmacy distribution. + Proven track record… more
- HCA Healthcare (San Antonio, TX)
- …cause of the denial/downgrade + Explanation of Benefits/Remittance Advice + Payer denial/DRG downgrade letters + Complex NCD/LCD guidelines, CMS/AHCA policies and ... Association, Food and Drug Administration, Medicare Administrative Contractors and payer websites + Escalates problem accounts/processes/trends and report opportunities… more
- Medical Center Hospital (Odessa, TX)
- …position requires the ability to retain large amounts of changing payer information/knowledge crucial to attaining reimbursement for the services provided. Primary ... as a liaison between the patient, the billing department and the payer to enhance account receivables performance, resolve outstanding issues and/or patient… more
- Cognizant (Austin, TX)
- …TypeScript and Adobe AEM to drive innovative solutions in the Provider and Payer domains. This work-from-home position offers a day shift schedule allowing you to ... scalable solutions that meet the needs of Provider and Payer domains. + Ensure code quality and maintainability by...+ Have a deep understanding of the Provider and Payer domains with experience in developing solutions tailored to… more
- Cardinal Health (Austin, TX)
- …practice. Managed Care oversees the interactions that take place between payer and provider(s) to ensure optimal reimbursement including managed care contracting, ... credentialing, and any other activity as it relates to payer interaction. Manager of Payor Contracting is responsible for...using knowledge of market, local and national benchmarks, and payer market. Key member of negotiating team for company.… more
- CVS Health (Austin, TX)
- …**Preferred Qualifications** + Experience leading complex initiatives within the payer clinical space is preferred + Experience identifying value opportunities ... risk management, product strategy, regulatory policy + Broad understanding of the payer landscape with ability to synthesize multiple disparate data points into a… more
- HCA Healthcare (San Antonio, TX)
- …activities, Detail analytical review of managed care revenue and contractuals, by payer , Global revenue and expense analysis and Global Balance Sheet account review. ... financial reports, specifically: Monthly Executive Summaries and Net Revenue by payer schedules. + Prepares annual facility budgets. + Conducts routine (monthly)… more
- Merck (Austin, TX)
- …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
- Houston Methodist (Houston, TX)
- …resources to initiate and verify authorization needed for prompt submission. Notifies the payer of the patient's admission or procedure in a timely manner, to ensure ... volume + Ability to review clinical documentation for Medical Necessity and payer requirements + Working knowledge of CPT, International Classification of Diseases… more
- Houston Methodist (Houston, TX)
- …language principles + Ability to effectively communicate with physicians, colleagues, and payer representatives in a manner consistent with a customer service focus ... Care requirements + Knowledge of community resources, health care financial and payer requirements/issues, and eligibility for state, local, and federal programs +… more
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