- Chiesi (CA)
- …This individual Will play a critical role in executing corporate payer strategy by developing strategic relationships, along with securing formulary and/or ... Work collaboratively with Sales and Marketing to effectively maximize current payer scenarios. Negotiate and execute formulary contracts where applicable, within the… more
- Baylor Scott & White Health (Dallas, TX)
- …charges, ensuring that services are compliant with federal, state, private payer , and other applicable legal and regulatory requirements. He/she is responsible ... charge edits to validate the accuracy of information and compliance with payer requirements. Exercise independent judgment in best practice for charging edit… more
- Specialty Rx, Inc. (Columbus, OH)
- …Support* Assist pharmacy sites in preparing for insurance audits and payer reviews* Provide documentation, reports, and operational support to meet federal, ... state, and payer compliance requirements* Apply for Emergency Kit (E-Kit) licenses for new facility starts and maintain oversight of all active E-Kit licenses… more
- Ascendis Pharma (Princeton, NJ)
- …and develop analogs for pricing strategies across therapeutic areas and track payer and PBM behavior, formulary decisions, and contract performance to inform pricing ... + Benchmark pricing strategies across therapeutic areas and geographies. + Track payer and PBM behavior, formulary decisions, and contract performance to inform… more
- UPMC (Pittsburgh, PA)
- …appropriate diagnostic/procedure billing codes, in compliance with third party payer requirements. + Monitor billing performances to ensure optimal reimbursement ... as needed. + Assess current CPT guidelines as well as other applicable payer coding policy changes. + Lead, participate in and/or assist with departmental coding… more
- Lundbeck (Los Angeles, CA)
- …and reimbursement team to ensure alignment of priorities and efforts between the payer and sales groups. + Leads budgeting and expense management for the Region. ... pharmacy benefit market with strong level of understanding of price, government payer , and specialty pharmaceutical markets + Previous success in managing and… more
- BGB Group (New York, NY)
- …of services, including traditional pharmaceutical advertising, promotional medical education, payer marketing, and consulting services. Known for excellence and ... mapping, and measurement + Strong grasp of healthcare ecosystems (HCP, patient, payer , caregiver) and the channel behaviors within each + Skilled in integrating… more
- Minnesota Visiting Nurse Agency (Minneapolis, MN)
- …issues related to the appropriate utilization of resources, coordination of payer communication, and utilization review and management. Responsible for carrying out ... process to manage and respond to all concurrent and post-discharge third party payer denials of outpatient and inpatient cases alleged to be medically inappropriate.… more
- Elevance Health (Richmond, VA)
- …that audits meet the industry's best practices and payer -specific requirements. .Collaborates cross-functionally with clinical, compliance, provider engagement, ... knowledge of medical claims billing/payment systems provider billing guidelines, payer reimbursement policies, billing validation criteria and coding terminology… more
- Nuvance Health (Danbury, CT)
- …Maintains accurate and timely claim submission for designated groups of accounts by payer . Insures that all claims are compliant with State and Federal billing ... follow-up of all delinquent claims. 3. Responds to all patient and payer inquiries, denials, correspondence & telephone inquires. 4. Maintains all reports (contract… more