- Texas Health Resources (Arlington, TX)
- …CPT, HCPCS) of professional charges in compliance with third party payer , NCCI guidelines and THPG policies. Maintains documentation to record/track coding ... variance. * Performs charge reconciliation. * Performs charge reconciliation of facility charges posted against OR/scheduled procedures to identify missed charges. Notifies leadership regarding discrepancies, collaborates with practice staff and providers to… more
- Stanford Health Care (Palo Alto, CA)
- …of the Emergency Medical Treatment and Active Labor Act (EMTALA), third-party payer regulations (eg, Medi-Cal, Medicare), and compliance with federal and state ... hospital laws and guidelines. + Clinical Skills: Strong clinical judgment for triaging patients, prioritizing care, and assessing patient needs; knowledge of medical terminology, health promotion, risk reduction, and disease management. + Communication Skills:… more
- R1 RCM (Detroit, MI)
- …of the top 100 US health systems, and handles over 270 million payer transactions annually. This scale provides unmatched operational insight to help healthcare ... organizations unlock greater long-term value. To learn more, visit: https://www.r1rcm.com . more
- UPMC (Oakdale, PA)
- …plan of cares. Sending documentation to physician offices to meet compliance and payer requirements. + Diploma from an accredited school of nursing required. BSN ... preferred. + 1 year previous specialized home health experience preferred. + 1 year clinical experience involving infusion therapy, including patient assessment skills, and venous access skills. + CPR certification required. + PICC training preferred. +… more
- Tenet Healthcare (Detroit, MI)
- …order to ensure accurate bill production. Ensures compliance with third party payer requirements. 6. Reconciles and corrects rejected erroneous data transactions as ... displayed on Transmission, Control and Errors (TCE) reports. 7. Accesses computerized system to enter and/or update electronic systems as needed and to answer patients, stakeholders and other pertinent parties inquiries. Responds to general inquiries as… more
- Trinity Health (Fort Lauderdale, FL)
- …to support medical group operational performance improvement. Produce reports to meet payer expectations and close care gaps required to optimize performance in ... value based contracts. Assists Directors in the development and maintenance of detailed reports for Physician/Provider Recruitment and onboarding to review the status of all recruitment efforts, and tracks physician/provider placement within HCMG. Supports and… more
- Trinity Health (Springfield, MA)
- …utilizing appropriate scripting. + Verifies active primary and secondary third-party payer insurance coverage eligibility with the payers via prescribes format. + ... Processes calls to ensure patients are transferred to the appropriate staff member/provider in a timely manner + Schedules patient appointments based on department protocols in order to maximize provider productivity. + Accurately registers patients ensuring… more
- Sutter Health (Emeryville, CA)
- …payment relationships for Sutter Health and supporting reinsurance arrangements and other payer risk agreements. Will dedicate a significant amount of time to ... pricing, product development, medical cost analytics, and valuation in support of Sutter Health's strategic growth plan and performance of Sutter's contracted network. Oversees the actuarial and underwriting departments which are charged with maintaining the… more
- Boehringer Ingelheim (Syracuse, NY)
- …top plans for customers. Engages customers in comprehensive discussions on the payer environment, co-pays, and formulary access. Works with Managed Care Area ... Managers to generate and sustain support for products on MCO formularies. Develops and influences an extended team to pull-through MCO decisions. Delivers on "continuation of care" model, including discharge protocol, treatment algorithms, disease management,… more
- TEKsystems (Philadelphia, PA)
- …will be looking at what the Provider send and coded for payment and what the Payer sent and coded for payment. They will be reviewing the case to decide which one ... is correct, is the correct code being used, and make a determination of what code and payment is recommended by MCMC. Then they pass it off to QA for review. They will do these cases over and over again to push them through. All of the cases are going to be… more