- Centene Corporation (Orlando, FL)
- …care management activities to ensure compliance with current state, federal, and third-party payer regulators + May perform home and/or other site visits to assess ... member's needs and collaborate with healthcare providers and partners + Provides and/or facilitates education to long-term care members and their families/caregivers on procedures, healthcare provider instructions, service options, referrals, and healthcare… more
- Teva Pharmaceuticals (Parsippany, NJ)
- …support. + Knowledge of pharmacy benefit vs. medical benefit processes, payer dynamics, and relationships with PBMs, specialty pharmacies, and insurers (including ... Medicare and Medicaid). + Strong analytical skills to evaluate vendor reporting, monitor performance, and identify areas for improvement. + Ability to mentor, coach, and guide new Vendor Managers and staff to strengthen operational capabilities. + Exceptional… more
- Hartford HealthCare (Norwich, CT)
- …through demonstrating critical decision making, analyzing insurance eligibility, analyzing payer conflicts, and ensuring authorization is on file. PAS Registrars ... are responsible for practicing sound decision making as it relates to patient privacy and safety standards. Patient Access is committed to anticipating the needs of patients and exceeding patient expectations; as well as, preparing patient charts, meeting… more
- 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
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