• Utilization Review Specialist Nurse (RN) | Case…

    Houston Methodist (Houston, TX)
    …nationally recognized acute care indicators and criteria as approved by medical staff, payer guidelines, CMS, and other state agencies. In addition to performing the ... of care and ensures prompt notification of any denials to the appropriate case manager , denials, and pre-bill team members, as well as management. The URSN position… more
    Houston Methodist (11/02/25)
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  • Director Digital Product & Experience Management

    Point32Health (Canton, MA)
    …our Point32Health market. This role requires a deep understanding of healthcare payer systems, digital product management, and user experience design, with the ... **Skill Requirements** + Strong experience within the health insurance or healthcare payer space. + Deep knowledge of health plan operations, member and provider… more
    Point32Health (10/30/25)
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  • Billing Specialist

    AnMed Health (Anderson, SC)
    …correct destination as defined by the requirements in the facility's various Third-Party Payer contracts. + Resolve issues with payer sources, reporting any ... ongoing problems to the appropriate manager or supervisor. Qualifications + High school diploma or GED. + Good communication skills, both written and verbal. + Prior… more
    AnMed Health (10/29/25)
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  • Pharmacy Program Coordinator - Specialty Pharmacy

    Cedars-Sinai (Beverly Hills, CA)
    …pharmacy analytics and reporting. Under the direction of the Pharmacy Manager , the coordinator applies data-driven methodologies to improve specialty pharmacy ... operations and monitor payer formulary and access changes. This position ensures compliance...quality and safety outcomes, engaging with external stakeholders regarding payer and limited distribution drug access, and managing data… more
    Cedars-Sinai (10/29/25)
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  • Admission Registration Lead

    Rush University Medical Center (Oak Park, IL)
    …functions consistent with Federal, State and Local regulatory agencies and payer requirements, and organizational policies and procedures, including HIPAA privacy ... process which is a required communication with the patient's payer to ensure that the payment for patient's inpatient...13. Other duties as needed and assigned by the supervisor/ manager . Rush is an equal opportunity employer. We evaluate… more
    Rush University Medical Center (10/28/25)
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  • Clinical Director Therapy

    Mental Health Association of SCK (Wichita, KS)
    …ethics and professional development. + Works with Senior Director/Billing Manager /Clinical Coordinator to ensure effective and efficient front office processes. ... and philosophy of the program. + Ensures compliance with payer systems, including utilization review functions. + Completes quality...license. Must be eligible for approval of 3rd party payer systems and apply for a variety of insurance… more
    Mental Health Association of SCK (10/27/25)
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  • Program Management Lead, Offshore Coding…

    CenterWell (Washington, DC)
    …identify educational opportunities. + Conduct research as needed. + Participate in Payer calls/chart reviews. + May participate in provider education programs on ... guidelines, healthcare regulations (including HIPAA, state and federal compliance), and payer requirements + Proficiency in Microsoft Office Suite (Word, Excel,… more
    CenterWell (10/23/25)
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  • Senior Accounts Receivable Specialist

    SERV Behavioral Health System (Hamilton, NJ)
    …through a wide range of services. JOB SUMMARY: Reporting to the Billing Manager , the Senior Accounts Receivable Specialist will be responsible for billing and ... all claims are coded accurately and comply with the payer 's requirements. + Monitors aging accounts receivable to identify...of Benefits to ensure payment accuracy based on active payer status. + Assists with the payment posting process… more
    SERV Behavioral Health System (10/07/25)
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  • Supervisor, Medical Coding

    University of Rochester (Rochester, NY)
    …and internal equity considerations._ **Responsibilities:** GENERAL PURPOSE The Assistant Coding Manager serves as a key support leader within the assigned functional ... area(s). This role provides assistance to the Manager by driving revenue cycle results through effective oversight of activities that impact professional charging… more
    University of Rochester (11/06/25)
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  • Prior Authorizations Spec 1 / PAS Fin Clearance…

    Hartford HealthCare (Farmington, CT)
    …in payer and or federal regulatory guidelines to their manager , pharmacy staff, providers and other clinical departments, as applicable. **_Position ... across the system. *_Position Summary:_* Under the direction of the Manager , Prior Authorization Services, HHC Cancer Institute, performs all clerical duties… more
    Hartford HealthCare (12/09/25)
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