- United Therapeutics (CA)
- …comes to Market Access. You love to cultivate and manage key payer relationships with identified Managed Care Organizations (MCOs), Pharmacy Benefit Managers (PBMs), ... Management: Establish and maintain UT's relationships with assigned National Accounts, KOL Payer stakeholders, and National Payer thought leaders. Identify and… more
- Sanofi Group (Cambridge, MA)
- …support indication selection, clinical development plans at all stages, broader payer data generation efforts, forecasts, and governance meeting, while also ... to the following: + Foundational knowledge of disease and payer unmet needs (through conducting secondary and primary ...payer unmet needs (through conducting secondary and primary payer research where relevant) + Early market access success… more
- Covenant Health Inc. (Knoxville, TN)
- …Office Services (KBOS), Billing Department regarding Out of State Medicaid Payer Enrollment, Hospital and Physician credentialing. With limited supervision, the ... Vendors. The specialist may do any of the following: Process payer enrollment, facility credentialing, physician enrollment, expirables, hospital credentialing /… more
- Emory Healthcare/Emory University (Atlanta, GA)
- …including billing, accounts receivable (AR) follow-up, denials management, and payer relationship management + Develops strategic direction, staffing models, and ... budgets to ensure compliance with payer regulations and organizational policies + Leads Senior Managers...as the subject matter expert for hospital billing strategy, payer policy interpretation, and revenue cycle best practices +… more
- CenterWell (Nashville, TN)
- …and continuous improvement of all authorization, insurance eligibility re-verification and payer maintenance for a large, complex Home Health organization operating ... operations supporting high-volume, multi-branch environments and ensures timely, compliant payer approvals to protect revenue integrity and patient access. The… more
- Regeneron Pharmaceuticals (Columbus, OH)
- …has proven to be highly challenging for HCPs and Patients. Payer Formularies and restrictive Utilization Management Criteria including Prior Authorization Processes, ... company and divisional reimbursement strategy for Regeneron products within various payer segments. The RBM position requires the ability to successfully navigate… more
- BrightSpring Health Services (Englewood, CO)
- …and healthcare professionals. TheRefund/Dispute Specialistis responsible for processing incoming payer refund requests by researching to determine whether the refund ... is appropriate or a payer dispute is warranted in accordance with applicable state/federal...other staff to identify, resolve, and share information regarding payer trends and provider updates. The employee must have… more
- Hartford HealthCare (Farmington, CT)
- …proper documentation and collaborating with other departments to address payer concerns. Key responsibilities include timely investigation of DRG downgrades, ... review of medical records, coding and clinical documentation to validate or appeal payer denials. . Prepare, document and submit appeals for DRG denials, ensuring… more
- Caris Life Sciences (Irving, TX)
- …to staff, while partnering cross-functionally to optimize workflows and resolve payer issues. **Job Responsibilities** + Lead and manage the Eligibility team, ... metrics, ensuring goals are met for turnaround time, accuracy, and payer compliance. + Collaborate with payers to resolve eligibility discrepancies, denials,… more
- Cognizant (Atlanta, GA)
- …Denial Prevention. You will perform advanced-level tasks related to healthcare payer claim line underpayments. Excellent written and verbal communication skills, ... proficiency in MS Excel, and familiarity with payer portals are essential. **Job Responsibilities:** + Utilizing the Advanced Reimbursement Analysis (ARM) tool to… more
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