- UCLA Health (Los Angeles, CA)
- …the pharmacy analytics field and recognized expertise in financial analysis/transactions, payer contracting, data analytics, and strategic planning. You will provide ... analytical and strategy support for highly complex budget, financial and resource projects supporting the growth of the ambulatory pharmacy department. You will exercise judgement in selecting methods, techniques and evaluating criteria for obtaining results.… more
- Sun Pharmaceuticals, Inc (Princeton, NJ)
- …areas + Relevant experience in pharmaceutical industry within commercial, medical, payer or academic institution + Good understanding of payers and reimbursement ... landscape + Working knowledge of pharmaco-economic principles + Ability to manage cross functional projects + Ability to analyze complex models and scientific data and draw out key messages + Understanding of FDA, ACCME, PhRMA regulations + Proficiency in… more
- Waystar (Atlanta, GA)
- …Consultant, Enterprise Rule & Edits position reports to our Enterprise Rules & Edits Manager and has the responsibility for establishing new client payer edit ... experience to advise clients in best practices and build a comprehensive payer edit library. The Consultant will partner with Client Operations, Client Success… more
- Covenant Health Inc. (Knoxville, TN)
- …This position demonstrates the ability to accurately submit claims in all payer categories, ie, Medicare, TennCare, Blue Cross, Commercial, and Managed Care. This ... position assists the Billing Coordinator, Billing Supervisors and Manager . Coordinates and prioritizes daily responsibilities including evaluating complex errors on… more
- Community Health Systems (Franklin, TN)
- …Functions** + Submits initial assessments, continued stay reviews, and payer -requested documentation, ensuring compliance with policies, regulations, and payer ... documentation of escalations, avoidable days, authorization numbers, denials, and payer interactions to ensure accurate records. + Coordinates Peer-to-Peer… more
- Guthrie (Sayre, PA)
- …Insurance Billing Specialists I and related support staff. Works closely with Director, Manager , Supervisor and Application Analyst on day to day priorities and to ... skills and proficiency in analyzing complex billing problems, prepares appeals, challenges payer policies and pursues appeal turnover when necessary. 4. Works with… more
- Community Health Systems (Franklin, TN)
- …hospital resource utilization, reduce readmissions, and maintain compliance with payer requirements. **Essential Functions** + Performs admission and continued stay ... to obtain necessary documentation for medical necessity, discharge planning, and payer requirements. + Documents all utilization review activities in the hospital's… more
- Henry Ford Health System (Detroit, MI)
- GENERAL SUMMARY:Under the direction of the Department Director or Manager , coordinates and facilitates operations in key department areas such as automation and ... to support timely and appropriate reimbursement. * Product Selection and Payer Formulary Review: Identify appropriate formulary medications, NDCs, and corresponding… more
- Beth Israel Lahey Health (Beverly, MA)
- …eligibility for visit, using various online tools and by contacting the payer directly. (essential) 2. Identifies payer medical necessity determination before ... 3. Determines authorization requirement and, when necessary, obtains authorization from payer by utilizing payer specific protocols. Requests and coordinates… more
- Commerce Bank (Kansas City, MO)
- …leading and managing the RCM dependencies of health plan and insurance payer remittance and payment enrollment activities for new client implementations across all ... leading and managing the RCM dependencies of health plan and insurance payer remittance and payment enrollment activities for new client implementations across all… more