- Specialty Rx, Inc. (Ridgefield Park, NJ)
- …procedures and requirements. + Stay updated on regulatory guidelines and payer policies related to high-cost drug authorizations. + Communicate effectively with ... internal teams and external clients regarding authorization status and issues. + Participate in training sessions and quality improvement initiatives to enhance authorization processes. + Assist in resolving any discrepancies or issues related to medication… more
- Fairview Health Services (Princeton, MN)
- …with payers on active authorized referral requests to verify determination or payer step in determination process. + Adhere to all compliance, regulatory ... requirements, department protocols and procedures. Protect patient privacy and only access information as needed to perform job duties. **Required Qualifications** + 2 years combination of customer service, other position in healthcare revenue cycle +… more
- Banner Health (Tucson, AZ)
- …through interactions and effective communication. 5. Proficient understanding of payer authorization guidelines. Accurately submits timely notification according to ... insurance guidelines using various systems to reduce/eliminate denials. Consistently meets all registration related key performance indicators as determined by management. 6. Obtains federal/state compliance information, consents and documentation required by… more
- Dignity Health (Long Beach, CA)
- …(ACM-RN) or UM Certification preferred + Knowledge of managed care and payer environment preferred. **Where You'll Work** CommonSpirit Health was formed by the ... alignment of Catholic Health Initiatives (CHI) and Dignity Health. With more than 700 care sites across the US from clinics and hospitals to home-based care and virtual care services CommonSpirit is accessible to nearly one out of every four US residents. Our… more
- Blue Cross and Blue Shield of Minnesota (Eagan, MN)
- …to work under tight time frames. * Knowledge of the health care industry, payer business models, business segments and products. * Proven ability to handle a variety ... of assignments in a fast paced and complex business environment. * Proven ability to define problems, collect and analyze data, establish facts and draw valid conclusions. * High school diploma (or equivalency) and legal authorization to work in the US… more
- University of Washington (Seattle, WA)
- …and maintain accurate records + Update patient demographic, financial, and payer information in applicable systems + Communicate with medical center staff, ... patients, and third-party payers to verify billing information and resolve concerns + Review patient account status and determine appropriate actions for resolution + Skip trace return mail accounts and analyze bankrupt or deceased patient accounts + Maintain… more
- Veterans Affairs, Veterans Health Administration (Smyrna, TN)
- …clinical information to third-party payers. Ensures compliance with established third-party payer criteria for reimbursement and appeal of clinical denials. Provides ... feedback as appropriate, for performance improvement, utilization management, and compliance related issues. Conducts precertification with third party-payers including VA and Community Care as applicable. Validates Service Connection (SC)/Special Authority… more
- Insight Global (Miami, FL)
- …correspondence. - Updates patient account information. - Monitors and identifies payer denial trends and problem accounts; communicates patterns to supervisor. - ... Runs a monthly aging report based on DOS and current A/R to identify accounts that require follow up. - Manage all assigned worklist daily for assigned insurances. - Utilize collection techniques to resolve accounts according to company's policies and… more
- Bristol Myers Squibb (Princeton, NJ)
- …knowledge of commercial data domains, including Customer 360, Incentive Compensation, Claims/ Payer , Omnichannel Engagement, and enterprise data assets as well as ... proficiency in leveraging syndicated/secondary datasets from leading vendors (IQVIA, Symphony Health, Veeva, Definitive Healthcare, AHA, AMA, Specialty Pharmacy, etc.) + Hands-on experience with predictive modeling, and AI/ML deployment in marketing contexts +… more
- Gentiva (Warner Robins, GA)
- …sources, and the care team * Assist with referrals, regulatory documentation, and payer compliance * Travel to various Gentiva hospice locations as assigned to fill ... urgent needs **Schedule & Travel:** This role typically follows a Monday-Friday schedule, with occasional on-call responsibilities. Travel is required and may include: + Option 1: Overnight travel required to cities within a 100-mile radius. + Option 2:… more