- Mount Sinai Health System (New York, NY)
- …- Case Management - MSH, Mount Sinai Hospital **Responsibilities** 1. **Admission: Payer Authorization & Denials Management.** Communicate with payer to obtain ... is established),_ follows up at regular interval to ensure payer response. Coordinate peer to peers _(ie If case...entered into electronic tracking system including the following: Process payer denial correspondence mail, end of day reports and… more
- CGI Technologies and Solutions, Inc. (Canton, MA)
- …will play a key role in driving interoperability initiatives for healthcare payer organizations. This role focuses on implementing solutions aligned with CMS and ... solutions such as FHIR APIs, Member Access APIs, Provider Directory APIs, Payer -to- Payer Data Exchange, and Prior Authorization APIs. . Analyze CMS/ONC… more
- Growth Ortho (Portland, ME)
- …payers. This role manages the complete lifecycle of credentialing and payer enrollment, maintains accurate records, and ensures compliance with regulatory and ... payer requirements to prevent revenue disruption. Key Responsibilities Provider...providers and locations. Manage Medicare (PECOS/855), Medicaid, and commercial payer enrollments, including PTAN/NPI linkages and location changes. Maintain… more
- Publicis Groupe (Morristown, NJ)
- …with tackling a labyrinth of payers and organized customers, with limited resources, payer marketers can sometimes feel trapped between a rock and-well you know. ... to rock in a hard space. Since day one, Payer Sciences has approached managed markets from a different...in sharp minds and multiple perspectives. To that end, Payer Sciences has assembled a flat and flexible organization,… more
- Addiction Recovery Care (Lexington, KY)
- …Key Responsibilities + Conducts root cause analysis of all assigned insurance payer claims and denials to determine appropriate actions required to resolve the ... accurate and supported reasoning based on EOBs, reimbursement, and payer specific requirements. + Builds relationships with MCO. +...necessary. + Organizes open accounts by denial type or payer to quickly address in bulk with representatives over… more
- Fairview Health Services (Minneapolis, MN)
- …contract proposal evaluations, claims payment accuracy reconciliation and pharmacy payer contract liaison activities. The Financial Analyst extracts and validates ... projections. + Tracking and updating of all third party payer fee schedules, internal charge masters, and payer... payer fee schedules, internal charge masters, and payer contracted payment methodologies. + Reviews charge levels against… more
- University of Rochester (Rochester, NY)
- …Email, third party claims systems (ePaces, Connex), Epic Billing System, and various payer web sites. **Typical Duties** **:** 40% Completes follow up activities on ... accounts by use of EPIC Insurance Coverage or the Payer Website link, online systems with insurance companies, and...third-party payers to obtain payments, as well as contact payer representatives to research/resubmit rejected claims to obtain and… more
- Baylor Scott & White Health (Dallas, TX)
- …and managed care payers, ensuring all processes comply with regulatory and payer requirements. The Director, Provider Enrollment guides the management team and staff ... to ensure facility enrollment applications are submitted promptly and payer provider numbers are obtained timely, supporting accurate and efficient payer … more
- Mount Sinai Health System (New York, NY)
- …of experience in healthcare analytics required + 4 years? experience with payer pricing models and payment methodologies required. + 4 years? experience developing ... and executing payer pricing strategies required. + Health plan experience in...modeling, payment methodologies, pricing strategy, market competitive intelligence and payer negotiation strategies. + Own the development and execution… more
- Takeda Pharmaceuticals (Boston, MA)
- …future products. You will also be responsible for value story development, payer /PBM contracting strategy, pricing, specialty pharmacy and distribution plans, and ... payer /channel marketing resources for in-line and pipeline products. **How...(HEOR), Marketing, Finance, Analytics, and Sales to capture relevant payer and channel insights, identify data gaps, develop compelling… more