- Aveanna Healthcare (Atlanta, GA)
- …timely. This includes billing for all primary, secondary, tertiary or any other payer for all unbilled accounts including any and all guarantors for services ... manager, supervisor, and branch location personnel informed of any significant billing payer or processing issues. Submits adjustments in an accurate and timely… more
- UNC Health Care (Hillsborough, NC)
- …care plans, tasks or interventions, care transitions, delegated work, and payer communication. The Care Manager works collaboratively with healthcare providers, ... management of patients' care as applicable per patient population. 7. Payer Communication: a. Collaborate with payers, insurance companies, and utilization… more
- Caris Life Sciences (Irving, TX)
- …requests, and apply acquired knowledge of Medicare, Medicaid, and other Third-Party Payer requirements **Job Responsibilities** + Adheres to all company policies and ... eligibility to ensure claims are billed accurately and in accordance to payer guidelines. + Ensures timely and accurate insurance authorizations are in place… more
- J&J Family of Companies (Cherry Hill, NJ)
- …product(s) to remain viable, updating practices on key private and public payer changes that impact infusion process, ensure staff in infusion clinics have ... territory's accounts and JJIM staff regarding local, regional and national payer policies; reimbursement regulations and processes (ie, eligibility and benefit… more
- Mohawk Valley Health System (Utica, NY)
- …Managed Care Programs, along with values- based care, pay-for-performance programs (all payer types) and reimbursement models in decision making and reviews. + ... and DRG assignment. Facilitate, mentor, and educate physicians regarding payer requirements, ICD coding guidelines (eg, co-morbid conditions, severity, acuity,… more
- BriteLife Recovery (Englewood, NJ)
- …to support insurance justification and compliance. + Maintain compliance with payer policies, HIPAA regulations, and internal utilization management protocols. + ... disorders. + Familiarity with managed care principles, insurance authorizations, and payer requirements. + Bachelor's degree in Nursing, Social Work, Psychology, or… more
- BrightSpring Health Services (Garden City, KS)
- …including the account names and terms of contracts or other past payer agreements, as appropriate. + Consults with third party representatives regarding client ... interprets potential reimbursement options and negotiates reimbursement levels with third party payer . + Contacts referral sources to advise them of case acceptance… more
- Cedars-Sinai (Los Angeles, CA)
- …Medicare Short Stay cases and assists with real-time management of concurrent payer denials. + This role ensures timely, accurate, and compliant clinical validation ... in accordance with CMS requirements and payer timelines. The UM RN collaborates with physicians, revenue integrity, and payer partners to complete post-discharge… more
- Bozeman Health (Bozeman, MT)
- …and compliance/audit management tools. + Intermediate knowledge of CMS guidelines, payer requirements, HIPAA Privacy and Security Rules, and foundational healthcare ... coding, and operational processes to evaluate compliance with applicable laws, regulations, payer rules, and internal policies. + Reviews medical and billing records… more
- Humana (Tallahassee, FL)
- …targeted action plans. + Customize strategies to align clinical programs with payer -specific needs (MA, D-SNP). + Provide clinical input into network development, ... + years in managed care industry, either provider or payer . + Thorough knowledge of health care utilization and...geographic boundaries **Preferred:** + Experience in both provider and payer roles + Prior executive level role with successful… more
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