- CommonSpirit Health (Englewood, CO)
- …utilization team and health information personnel. + **Conducts peer-to-peer reviews with payer medical directors to discuss and advocate for the medical necessity ... or hospitalizations. Presents clinical rationale, addresses concerns raised by the payer , and provides additional context to overturn denials before escalation to… more
- Northwell Health (Melville, NY)
- …+ Serves as liaison between the patient and facility/physician and the third party payer . + Prepares and defends level of care and medical necessity for assigned ... length of stay. + Ensures compliance with current state, federal, and third-party payer regulations. Ensures clinical reviews and appeals are up to date and… more
- UnityPoint Health (Muscatine, IA)
- …file for each patient. + Obtains information and completes MSPQ and other payer -specific documents. + Reviews and explains all registration forms prior to obtaining ... coinsurance as applicable after developing an estimate applying allowable (based on payer ). Qualifications Education: + Requires a high school diploma or GED… more
- NYU Rory Meyers College of Nursing (New York, NY)
- …Directly manage and resolve all assigned underpayment appeals, follow-up and payer relationships. Report to management any gross payment discrepancies by payers. ... Contact payer to resolve appeals and final solution to claims. Collaborate with the Director of Insurance Strategy in developing, implementing and maintain… more
- HCA Healthcare (Reston, VA)
- …as an active member of the interdisciplinary team. + Communicates pertinent payer needs/requirements to physician, treatment team, patient and patient's family in a ... maintains effective working relationships with patients, families, co-workers, physicians, payer representatives, hospital administration, community members, and referral sources.… more
- University of Southern California (Los Angeles, CA)
- …assessments upon discharge. * Completes clinical reviews timely and communicates to appropriate payer . * Able to prioritize clinical reviews. * Documents payer ... communication and authorization in the Authorization log. * Completes and submits TAR's for processing within 3 working days of patient discharge. * Notifies director and physician advisor timely of patients who do not meet InterQual criteria. * Other duties… more
- Community Health Systems (Antioch, TN)
- …operations required + Demonstrated expertise in analyzing and interpreting payer contracts and reimbursement methodologies required **Knowledge, Skills and ... interpretation skills. + Advanced understanding of healthcare reimbursement systems and payer contracts. + Excellent leadership and team collaboration abilities. +… more
- Penn Medicine (Philadelphia, PA)
- …Supervisor of areas of concern + Prepares monthly Case Mix Index Analysis: including by Payer by Service and by Service by Payer analysis. + Ensures that all ... sizable weight Transplant and Trach cases on In-house reports are also accrued for in calculations + Complete supporting schedules and flux analyses + Prepare monthly journal entries and account analyses in an accurate and timely fashion + Complete monthly… more
- Trinity Health (Ann Arbor, MI)
- …that patients meet financial requirements including Medicare medical necessity, payer pre-certifications & referrals. Provides general information to hospital users, ... Responsible for analyzing, processing & editing for correctness based on payer guidelines. Resolves items & ensures claims are billed accurately. Processes… more
- Adecco US, Inc. (Irving, TX)
- …manufacturer partners to resolve reimbursement challenges and deliver critical education on payer landscapes and available support services. The FRM acts as a ... Education (25%)** - Educate providers on benefit verification, prior authorization, payer trends, and support center services. Document and report all interactions… more
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