- St. Luke's Health System (Boise, ID)
- …is truly a great place to work. **Overview:** The Pharmacy Benefits Specialist assists our members in identifying and navigating complex pharmacy benefits management ... on resolving claim rejections, copay assistance programs, and escalated prior authorization appeals . + Will assist in preparing for and leading team member meetings.… more
- United Therapeutics (Melbourne, FL)
- …which transplant is not currently an option. The Access & Support Specialist provides limited reimbursement support services to healthcare providers and patients in ... to effectively handle questions pertaining to prior authorizations, denials and appeals + Essential telephone and electronic communication skills + Demonstrated… more
- Commonwealth Care Alliance (Boston, MA)
- …issues. + Collaborate closely with Provider Relations, Contracting, Payment Integrity, Appeals & Grievances, and Configuration teams to validate and resolve ... reimbursement concerns. + Conduct retrospective audits to identify systemic payment issues and recommend resolution pathways. + Interpret and apply MassHealth fee schedules, All-Payer Rate Setting regulations, and CMS payment methodologies (eg, DRG, APC,… more
- Queen's Health System (Honolulu, HI)
- …meetings with payors to resolve payment and denial issues. * Writes and submits appeals to payors on denied accounts. * Audits payments to ensure QMC has received ... contracted payment in accordance with contract terms (including outlier accounts), including performing zero balance analysis. Creates, reviews and distributes accounts receivable reports on denials, audits, payment trends, and AR status. * Meets with… more
- Option Care Health (Columbia, SC)
- …Assists with Billing and Collection Training and completes "second level" appeals to payers. **Job Description:** **Job Responsibilities:** + Submits timely, ... accurate invoices to payer for products and services provided. Understands the terms and fee schedule for all contracts for which invoices are submitted. Correctly determines quantities and prices for drugs billed. Verifies that the services and products are… more
- MetLife (Cary, NC)
- …and thorough manner. Identifies and refers appropriate matters to our appeals , complaint, or litigation support areas. Essential Business Experience and Technical ... Skills: Required: * New hires should live a commutable distance from the site the role is posted in * High School Diploma * Minimum 2 years of experience in external customer service or related experience * Demonstrated critical thinking in activities… more
- Exelon (Philadelphia, PA)
- …and sale of property and property rights, property tax assessments and appeals , property management and other real estate related matters. (40%) + Negotiates ... contract and agreement terms; prepares contracts, deeds, leases, easements and other real estate documents; reviews property surveys, legal descriptions, engineering drawings, applications for facilities attachments, appraisals, other legal documents and… more
- Serco (Washington, DC)
- …+ Written communication skills (eg, drafting program impact statements and Congressional Appeals ) + Experience leading a project and interfacing with an end item ... to: [email protected] . Click here to apply now (https://careers-sercous.icims.com/jobs/72127/submarine-certification- specialist washington%2c-d.c./job?mode=apply&apply=yes&in\_iframe=1&hashed=-1834477830) **New to Serco?** Join our Talent… more
- University of Rochester (Rochester, NY)
- …edits, and obtains signatures for non-routine letters of correspondence related to appeals on denied claims, including compiling all necessary information and drafts ... for provider signature. + Manages provider(s) documentation and information. + Composes and types of non-routine correspondence providing factual information. + Arranges travel, conference registration, and hotel accommodations. Interfaces with organizations,… more
- Avera (Sioux Falls, SD)
- …completing prior and pre-authorizations for patients insurance companies, working appeals for insurance coverage, verifying benefits, making referrals and scheduling ... pre-operative physical, and reviewing surgery information with patients. Responsible for scheduling, maintaining, and disseminating an accurate surgery schedule, including acquisition, retention, and organization of documentation, and will provide clerical… more