- PeaceHealth (Vancouver, WA)
- …clinical risk management risk investigations and response to events, potential claims , and grievances presented against caregivers, physicians and the organization ... for potential or actual liability and damages. Collaborating with Claims , collects documents and evidence and maintains work product in accordance with state legal… more
- Blue Cross and Blue Shield of Minnesota (Eagan, MN)
- …Network and Pharmacy , ensuring data is pulled using the most representative methods. They also support high-risk regulatory reporting, where precision and speed ... synthesizes data across multiple domains, including utilization management, prior authorization, claims , denials, and appeals. Their work goes beyond extraction; it… more
- CVS Health (Boston, MA)
- …as well as navigating them through the health system, providing support on claims issues, and answering coverage-level questions. **We have two of these roles to ... any benefits related issues including answering routine questions, addressing denied claims , preauthorization, and providing support to both the employees and the… more
- KPH Healthcare Services, Inc. (Gouverneur, NY)
- …GED, or equivalent experience **Experience:** + Preferred: 0-2 years experience as a Pharmacy Technician or Customer Service Representative in a health care ... issues to ensure complete client satisfaction. + Provide Help Desk resolution of Pharmacy Network problems to ensure complete client satisfaction. + Assist with the… more
- Commonwealth Care Alliance (Boston, MA)
- …and inbound call support + Leverages internal and external resources (such as claims , referrals, and pharmacy data) to identify accurate, successful contact ... Language(s)** Bilingual preferred **Other** + The physical demands described here are representative of those that must be met by an employee to successfully… more
- Henry Ford Health System (Troy, MI)
- …with insurance payors regarding authorization issues. May be the hospital representative at external meetings which involve HFH management. Ensuring that services ... accuracy prior to claim submission Managing authorization related denied claims to ensure the highest rate of payment recovery...a full suite of home health offerings, virtual care, pharmacy , eye care and other health care retail. With… more
- Avera (Sioux Falls, SD)
- **Location:** Avera Long Term Care Pharmacy **Worker Type:** Regular **Work Shift:** Day Shift (United States of America) **Pay Range:** _The pay range for this ... the preparation, completion and filing of third party payor insurance reimbursement claims , both electronic and paper formats. + Processes explanation of Medicare… more
- Henry Ford Health System (MI)
- …with insurance payors regarding authorization issues. May be the hospital representative at external meetings which involve HFH management. + Ensuring that ... prior to claim submission + Managing authorization related denied claims to ensure the highest rate of payment recovery...a full suite of home health offerings, virtual care, pharmacy , eye care and other health care retail. With… more
- Avera (Sioux Falls, SD)
- …answer clinical questions during authorization process. Communicate with care team and pharmacy staff to ensure that all treatments meet medical necessity. Draft ... Facilitate resolution of patient billing issues which may include appealing denied claims . . Work in collaboration with the patient, insurance, and business office.… more