- Baystate Health (Springfield, MA)
- …comprehensive coverage and sponsorship possible. **6)** Maintains knowledge of payer guidelines pertaining to benefit, eligibility, and authorization information by ... use of web portals and carrier communications. **7)** Correct/update patient and guarantor demographic, financial and insurance information in appropriate systems. Ensure that all data collected fulfills requirements for claim submission to third parties.… more
- Community Health Systems (Las Cruces, NM)
- …and professional manner. + Working knowledge of Federal and State insurance regulations and payer regulations + Ability to work effectively as a member of a team. ... INDNC Equal Employment Opportunity This organization does not discriminate in any way to deprive any person of employment opportunities or otherwise adversely affect the status of any employee because of race, color, religion, sex, sexual orientation, genetic… more
- HCA Healthcare (Miami, FL)
- …thorough working knowledge of the rules of Medicare, Medicaid, and private payer regulations and processes. You will possess a thorough understanding of managed-care ... concepts and length-of-stay management relating to patient and organizational fiscal responsibility. + You will perform thorough assessments and develop appropriate discharge plans for high-risk patients with discharge planning or psychosocial needs. + You… more
- Beth Israel Lahey Health (Beverly, MA)
- …their homes and communities in accordance with home care regulations and payer guidelines. **More Specifically** : + Complete and document an initial assessment ... of patient and family to determine home care needs; + Initiates the plan of care and makes necessary revisions as patient status and needs change; + Administers medications and treatments as prescribed by the physician; + Instruct, supervise, and evaluate the… more
- Erickson Living (Novi, MI)
- …the community continuum of care. + Following Federal, State, and all Payer guidelines, ASHA requirements, and company policies and procedures. Ensuring departmental ... understanding and compliance in the areas of care provision, documentation, billing reimbursement, resident rights, customer service, and compliance. + Providing a holistic approach, supporting the residents' physical, spiritual, emotional, and clinical needs… more
- Fairview Health Services (Minneapolis, MN)
- …coordination provided is situational and appropriate based on patient need and payer requirements. This position is accountable for the quality of clinical services ... delivered by both them and others and identifies/resolves barriers which may hinder effective patient care. This position has responsibility to determine how to best accomplish functions within established procedures, consulting with leader on any unusual… more
- Amergis (Orange, CA)
- …HMIS experience required, CalOptima Connect experience preferred (or + comparable payer portal). Roles and duties: + Comprehensive Case Management: Conduct intake ... assessments, develop housing sustainability plans, monitor client progress, and provide mobile advocacy and crisis intervention using trauma-informed care. + Resource Coordination: Connect clients to essential services like Cal Fresh, General Relief, Cal Aim,… more
- CCSI INC (Norwich, NY)
- …updates plan, policies and procedures as warranted to reflect changes in law, regulations, payer requirements or CCCMHS operations. + Stay active and up to date on ... all material and releases regarding regulatory compliance. + Establish Annual Compliance and Quality Work Plan and Audit Schedule for review/approval by the Compliance Committee, Director of Community Services, and Community Services Board (CSB). + Regularly… more
- Beth Israel Lahey Health (Beverly, MA)
- …their homes and communities in accordance with home care regulations and payer guidelines. **More Specifically** : + Coordinate care for assigned patient caseload ... including but not limited to: delegating to and supervising of PTA staff (if applicable), processing patient condition change visits, and completing OASIS time points. + Complete and document an initial assessment of patient and family to determine home care… more
- Beth Israel Lahey Health (Westwood, MA)
- …prescriptions. + Develop and master an understanding of product and payer reimbursement landscape and prior authorization guidelines and processes. Collects and ... communicate all data needed to facilitate prior authorization approvals. Convey status updates as appropriate including information with appeals. + Provides exceptional customer service to internal and external customers. Resolves any customer requests in a… more