- SERV Behavioral Health System (Hamilton, NJ)
- …+ Ensures all claims are coded accurately and comply with the payer 's requirements. + Monitors aging accounts receivable to identify overdue accounts. + ... + Reviews Explanation of Benefits to ensure payment accuracy based on active payer status. + Assists with the payment posting process when needed. + Ensures… 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 case. ... continued 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
- University of Miami (Miami, FL)
- …division/specialty/provider, resource availability, special needs, timeframes, medical necessity, and payer and contractual guidelines. + Assists leadership with the ... pathology, laboratory, and state/ federal regulations. Oversees the Medicare Secondary Payer Questionnaire (MSPQ) process in accordance with Centers for Medicare &… more
- Highmark Health (Monroeville, PA)
- …Documents, monitors, intervenes/resolves and reports clinical denials/appeals and retrospective payer audit denials. Collaboratively formulates plans of action for ... to all AHN staff regarding utilization review practice and governmental commercial payer guidelines. Adheres to the policies, procedures, rules, regulations and laws… more
- Mohawk Valley Health System (Utica, NY)
- …of the HB follow up groups. Core Job Responsibilities + Organize and maintain payer spreadsheets + Meet with and brief supervisors on claims issues contained in the ... spreadsheets prior to monthly payer meetings + Administration of website access for business office staff and other departments and vendors in need of access to… more
- St. Luke's Health System (Boise, ID)
- …is to reduce financial barriers and delays in care while adhering to payer guidelines. + Works with providers, pharmacists, pharmacy staff, coders, and insurance ... treatments, medical necessity guidelines, clinical documentation, medical policies, and payer requirements to prevent treatment delays and ensure compliance. +… more
- Trinity Health (Boise, ID)
- …of providers out of network recommendation, assuring services are not available within the payer and or SAHA networks. This leads to either site of care redirect or ... payer approval or denial of out-of-net network services. **What Will You Do** **:** + Maintain comprehensive knowledge of provider networks, care management… more
- TEKsystems (West Des Moines, IA)
- …timely feedback to management of identified claims issues, repetitive errors, and payer trends to expedite claims adjudication + Work accounts in assigned queues ... Skills & Qualifications Must have knowledge in the Medicaid space Experience with payer platforms Billing/follow up experience OR worked for a Clinic using EPIC… more
- Regeneron Pharmaceuticals (Sleepy Hollow, NY)
- …payers, providers, and policy stakeholders to understand evolving access dynamics; integrate payer insights with patient and HCP perspectives to create a holistic ... frameworks and agreements that align with customer needs and payer expectations; provide insights into value-based pricing models, reimbursement strategies… more
- Fresenius Medical Center (Mesa, AZ)
- …+ Regularly conducts client meetings to review accounts receivable performance, payer issues and KPI trends, client's business strategies, and cash flow ... of all Client Management deliverables (including A/R measurement statistics and payer trends, fee schedules, ad hoc financial reports) ensuring their relevancy,… more