- Penn Medicine (Philadelphia, PA)
- …Receivable Supervisor manages the accounts receivable and associated staff for assigned payer (s). This position will also identify, report, and resolve issues to ... of accounts. Responsibilities: + Evaluates effectiveness of strategies by tracking payer key performance indicators and implementing corrective actions as necessary… more
- Omaha Children's Hospital (Omaha, NE)
- …accurate and supported reasoning based on EOBs, medical records, and payer specific requirements. Resubmit claims with necessary information and medical records ... when requested by payer through paper or electronic methods to ensure payments...party payors. Organize open accounts by denial type or payer to quickly address in bulk with representatives over… more
- Fairview Health Services (St. Paul, MN)
- …maintain appropriate pricing across all service lines in collaboration with Payer Relations, Finance, and operational leaders. The Specialist proactively identifies ... + Ensures alignment with CPT/HCPCS coding standards, NUBC guidelines, revenue codes, payer requirements, and regulatory mandates. + Partners with Payer Relations… more
- University of Rochester (Rochester, NY)
- …up activities on denied, unpaid, or underpaid accounts, as well as contacts payer representatives to research and resubmit rejected claims to obtain and verify ... working claims. + Reviews reasons for claim denial. + Reviews payer website or contacts payer representatives to determine why claims are not paid. + Determines… more
- Guidehouse (Chicago, IL)
- …is dedicated to managed care contracting - you will learn to read payer contracts (commercial and government), model reimbursement terms in our existing tools, and ... turn findings into clear, executive-ready recommendations. + Learn and interpret payer contracts (fee schedules, DRG/APC, per diem, percent-of-charge, case rates,… more
- BrightSpring Health Services (Colorado Springs, CO)
- …the referral to the branch + Responsible for keeping staff current with payer requirements and Amerita policy and procedures related to the intake process, CPR+ ... in local and regional payor requirements, ensuring team alignment with policy changes and payer nuances + Acts as an escalation point for complex or high impact… more
- Community Health Systems (Franklin, TN)
- …to ensure timely reimbursement. This role requires in-depth knowledge of payer guidelines, systems, and requirements to navigate complex denial cases effectively, ... for clinical appeals as needed. + Files and monitors appeals to resolve payer denials, documenting all activity accurately and maintaining logs, account notes, and… more
- KPH Healthcare Services, Inc. (Hoffman Estates, IL)
- …up on pending unresolved coverage issues + Obtaining initial authorization from payer sources to begin services + Obtains authorization from insurance companies and ... Verifying eligibility on a continues basis with all insurance carriers + Communication payer verification or benefits issues + Facilitating follow-up with payer … more
- Teva Pharmaceuticals (Parsippany, NJ)
- …cross-functional teams, collaborating with global markets to ensure commercial success and payer alignment. This role can be based in the US, the Netherlands ... medicines. + Value Proposition Development: Craft early value narratives and payer messaging to guide evidence generation and support successful reimbursement. +… more
- University of Utah Health (Salt Lake City, UT)
- …all actions and information shared with care team members or third-party payer . + Alerts and discusses with physician/provider and case manager/discharge planner ... cost, or over/under-utilization of resources. + Performs verbal/fax clinical review with payer as determined by nursing judgment and/or collaboration with the … more