- 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
- Amgen (Washington, DC)
- …lead development and implementation of reimbursement strategies for federal (US) payer issues across multiple therapeutic areas and the company's biosimilar ... independently, he/she may also conduct research and integrate clinical, market and payer data to inform engagement on reimbursement objectives. The Health Policy… more
- AbbVie (Mettawa, IL)
- …Value & Access Teams, they coach their team to influence access strategies, payer value propositions, and deliverables for both marketed and pipeline assets, while ... of integrated Value & Access teams, providing direction for access strategy, payer value propositions, and critical deliverables. + Support business development by… more
- Amgen (Washington, DC)
- …cycle management The HEOR Book of Work comprises generating global-impact payer -relevant evidence, patient reported outcomes (PRO) and clinical outcomes assessment ... execution. The HEOR Senior Manager must have experience in developing payer -relevant evidence generation, PRO/COA strategy, evidence synthesis and HTA requirements.… more
- University of Miami (Miami, FL)
- …+ Follows the authorization process using established criteria as set forth by the payer or clinical guidelines + Accurate review of coverage benefits and payer ... the treatment plan, serves as a resource to provide education regarding payer policies and assists with coordination of alternative treatment options + Ensures… more
- AbbVie (Irvine, CA)
- …ideal candidate will have a strong understanding of US private and public payer segments, pharmacy and medical benefit reimbursement, buy and bill models, and the ... across several roles is preferred. + Expertise in developing compelling early payer value propositions preferred. + Experience leading primary and secondary payer… more