- HCA Healthcare (Denver, CO)
- …market. Oversees the following: . All data analytics and supports value-based payer contracting activity . Payer relations and contract negotiation management ... Creates the financial statements and HOCCP. Reports financial status to Boards. Payer relations and contract management: . Supports payor contract negotiations and… 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
- 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
- Catholic Health Services (Rockville Centre, NY)
- …and optimizing healthcare reimbursement strategies and ensuring compliance with payer regulations and government reimbursement methodologies. This position plays a ... + Analyze reimbursement trends and financial impacts of regulatory changes, payer contract terms, and proposed healthcare legislation. + Develop financial models… more
- Tetrad Digital Integrity LLC (Washington, DC)
- …scale, delivering healthcare and housing services through a complex payer technology ecosystem that supports both government-aligned and commercial health ... + Lead architecture design for complex, multi-system integrations across enterprise payer platforms + Participate in governance forums - Architectural Review Board… more
- Adecco US, Inc. (Knoxville, TN)
- …Type:** Temp to Hire **Primary Responsibilities** + Process payer enrollment, facility credentialing, hospital credentialing, and re-credentialing applications ... data in credentialing databases (Visual Cactus preferred) and state-level payer systems + Follow up on payer ...state-level payer systems + Follow up on payer enrollment status, reappointments, demographic changes, and coverage updates… more
- Nuvance Health (Danbury, CT)
- …specialized system skills, best practice application of i? 1/2investigatingi? 1/2 payer practices, successfully challenging payers as they prevent obstacles and deny ... claims and escalating any egregious payer behaviors to internal leadership for assistance in resolution...Care Guidelines or CMS 2 Midnight Rule (depending on payer ) within 12-24 hours of admission, seven days a… more
- Sanofi Group (Cambridge, MA)
- …eg Payers, that inform value to decision makers. This role will leverage payer interactions to identify strategies that will improve the impact of research and ... recommendations to clinical development programs aimed at ensuring differentiation for payer value demonstration + _Has US product launch experience, understand US… more
- Northwell Health (Lake Success, NY)
- …reimbursement methodologies. * Strong understanding of state, federal, and payer -specific regulations related to billing, collections, and compliance. * Bilingual ... insurance verification, benefits investigation, prior authorizations, and re-authorizations using payer portals, electronic systems, and direct payer … more
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