- Seattle Children's (Seattle, WA)
- …region payors. This role collaborates with the Complex Authorization Team, Contracting and Payer Relations and our medical partners (SCCA, UWP, UWMC), and ... The Revenue Cycle Complex Account Specialist (CAS) role is responsible for handling the complex billing, follow up and payment allocation for specialized medical… more
- Waystar (Atlanta, GA)
- **ABOUT THIS POSITION** The Payer Relations Specialist is responsible for initiatives to identify and build contractual relationships with payers for direct ... a key member of the Waystar payer relations team, the Payer Relations Specialist will drive new value for Waystar's clients by unlocking new… more
- Johns Hopkins University (Baltimore, MD)
- …with Medicare regulations. + Epic experience and understanding of third-party payer issues Classified Title: Coding Specialist II Role/Level/Range: ATO ... We are seeking a **_Coding Specialist II_** who will be responsible for all...aspects of coding, quality assurance, and compliance with federal payer documentation guidelines. Works closely with department management and… more
- Community Health Systems (Franklin, TN)
- …in care management preferred + 1-2 years of experience in utilization management, payer relations , or hospital revenue cycle preferred **Knowledge, Skills and ... **Job Summary** The Clinical Utilization Review Specialist is responsible for evaluating the necessity, appropriateness, and efficiency of hospital services to… more
- Johns Hopkins University (Baltimore, MD)
- …**Preferred Qualifications** + Epic experience. + Understanding of third party payer issues. Classified Title: Coding Specialist II Role/Level/Range: ATO ... We are seeking a _Coding Specialist II_ is responsible for understanding all aspects...aspects of coding, quality assurance, and compliance with Federal payer documentation guidelines. Works closely with departmental management and… more
- University of Southern California (Alhambra, CA)
- …compliance regulations and guidelines, the HIM Coding Denials Management Specialist " analyze, investigate, mitigate, and resolve all coding-related 'claims denials' ... versus clinical-related denials, evaluating claims deemed inappropriately paid by the payer /external auditors, and determining the need for appeal. Performs all 1st… more
- East Boston Neighborhood Health Center (Revere, MA)
- …Locations: 300 Ocean Avenue - Revere Position Summary: The Provider Enrollment Specialist is responsible for supporting the provider enrollment processes of the ... actions are performed at the time of provider departure. The Provider Enrollment Specialist verifies that data obtained from the provider and internal and external… more
- Charles B. Wang Community Health Center (Queens, NY)
- …in electronic health records + Establish linkage to external social services programs, specialist services and payer 's care management services + Participate in ... and ability to utilize the care plans + Communicate and establish effective working relations with care team + Advocate and work with patient and patients' family to… more
- Intermountain Health (Wheat Ridge, CO)
- …for effective pre-registration and pre-visit preparation as needed. Also collaborates with Payer Relations to provide the required documentation relating to any ... denial or appeal information needed. All other duties as needed + Utilization of different insurance platforms and medical records systems according to department protocols to include accurate data entry and retrieval of information for reporting purposes. +… more
- Commonwealth Care Alliance (Boston, MA)
- …interpretation, and fee schedule issues. + Collaborate closely with Provider Relations , Contracting, Payment Integrity, Appeals & Grievances, and Configuration teams ... and recommend resolution pathways. + Interpret and apply MassHealth fee schedules, All- Payer Rate Setting regulations, and CMS payment methodologies (eg, DRG, APC,… more
