- Catholic Health Services (Melville, NY)
- …and that required clinical criteria is complete and accurate according to payer requirements. The role will work closely with Utilization Management, Patient ... DUTIES/RESPONSIBILITIES: + Determine whether authorization is required and utilize payer -specific requirements to secure authorization. + Submit prior authorization… more
- WellLife Network (NY)
- …point for complex claim or payment issues requiring advanced knowledge of payer rules, coding and reimbursement guidelines. 5. Ensure compliance with federal and ... state regulations, payer contracts, and organizational policies. 6. Collaborate with clinical...of CPT, ICD-10, and HCPCS coding principles. + Knowledge of, HMO/PPO, Medicare, Medicaid, and other payer requirements and… more
- Robert Half Finance & Accounting (Carlisle, PA)
- …and reimbursement trends to identify and implement performance improvements. * Handle payer contracts, denial management, and appeals to ensure accurate and timely ... or a related field is required. * Strong expertise in billing, coding, payer compliance, and revenue cycle systems. * Knowledge of Medicaid, Medicare, and commercial… more
- Takeda Pharmaceuticals (Boston, MA)
- …with internal teams to bring all issues to a satisfactory resolution. + Gather Payer claim level data files, reconcile Payer invoices and perform detailed ... and process rebates and fees within ModelN FLEX revenue management system for both Payer and GPO contracts. Support data requests from US OBU Patient Value & Access… more
- Henry Ford Health System (Detroit, MI)
- …denial management, and collections. Ensure compliance with state, federal, and payer requirements to optimize reimbursement and financial outcomes. Collaborate with ... access hub providing seamless patient access, minimize claim denials, and resolve payer issues for infusion and injection therapies. + Data Analytics & Business… more
- University of Southern California (Arcadia, CA)
- …functions within this role include: facilitation of pre-certification and payer authorization processes, facilitation of the collaborative management of patient ... to facilitate covered day reimbursement certification for assigned patients. Discusses payer criteria and issues on a case-by-case basis with clinical staff… more
- Mount Sinai Health System (New York, NY)
- …team and executive director number of patients waiting for authorization by payer . 17. Provides documentation to support delay in discharge billing related to ... authorization delay or network inadequacy issues by payer to contracting team and billing department. 18. Reports...and billing department. 18. Reports monthly on LOS by payer and total number of day delays contributing to… more
- KPH Healthcare Services, Inc. (Longview, TX)
- …records of all collection activities, including communication with payers and patients. + Payer projects as assigned. + Identify and report trends in claim denials ... Wellsky, and CareTend, etc.) + Understanding of various insurance plan benefits, payer payment policies, and reimbursement procedures. + Deep understanding of home… more
- East Boston Neighborhood Health Center (East Boston, MA)
- …portals, revenue cycle policies and procedures, productivity protocols, and payer policies and regulations. Develops course outline, objectives, proficiency testing ... Conference and formal training with certification. + Participates in payer , vendor, or healthcare industry events and training. +...Cycle experience + 3 to 5 years of Massachusetts payer healthcare experience + 3 to 5 years of… more
- Mount Sinai Health System (New York, NY)
- …+ Monitor key performance indicators (KPI) such as initial and final denials, payer performance, staff productivity and quality touches, aged AR trends and billing ... health system business leaders and managed care to review payer issues and denials. + Builds effective, collaborative relationships...+ Maintains strong understanding of revenue performance metrics and payer mix and leads team in building plans to… more