- Blue Cross Blue Shield of Massachusetts (Hingham, MA)
- …to work in our Hingham office 1x month.Key Responsibilities: + Conduct pre - certification , concurrent, and retrospective reviews with emphasis on utilization ... management, discharge planning, care coordination, clinical outcomes, and quality of service. + Evaluate members' clinical status, benefits, and appropriateness for programs and sites of service to develop a cost-effective, medically necessary plan of care. +… more
- Texas Health Resources (Fort Worth, TX)
- …flows efficiently. * Obtains and/or updates verification of benefits and/or pre - certification for applicable tests and/or procedures * Prepares, presents, ... and thoroughly explains applicable legal, ethical, and compliance documents; ensures proper consents are signed by the appropriate parties. Maintains documentation of the same * Maximizes reimbursement for services rendered by appropriately identifying… more
- Penn Medicine (Plainsboro, NJ)
- …services and co-payments, payment reconciliation and deposit, processing referrals and pre - certification of procedures for a multi-specialty physician outpatient ... practice located in a hospital environment. Responsibilities: + Perform work accurately, thoroughly, and in accordance with departmental and PHCS/PHMA standards. Identify problems and refer them/offer suggestions appropriately. + Maintain a positive approach… more
- Texas Health Resources (Bedford, TX)
- …correct network coverage and obtains and/or validates healthcare benefits and/or pre - certification for applicable tests and/or procedures. These efforts maximize ... reimbursement for services rendered. . **Educates patients and/or families** about applicable legal, ethical, and compliance documents; ensures regulatory consents are signed by the appropriate parties. . **Engages with patients** in understanding their… more
- Catholic Health Initiatives (Lexington, KY)
- …for answering phone calls and scheduling patient appointments. + Conduct patient pre - certification to ensure coverage for appointments and medical care. + ... Schedule tests, procedures, and referral appointments. + Communicate with patients regarding appointments and instructions for procedures and tests + Collect insurance information and patient personal data. + May collect fees such as co-pays / co-insurance. +… more
- Owens & Minor (Anaheim, CA)
- …via phone, fax, and web portal * Ability to submit authorizations or pre - certification request to multi-state payers over multiple platforms. * Communicate ... effectively and professionally with customers, teammates, healthcare professionals, and sales team * Reviews and approves documentation received by third parties for submission to payors for reimbursement * Effectively document activities in ERP system in an… more
- Aveanna Healthcare (Seal Beach, CA)
- …upon receiving information from the clinical team for services that require pre certification /authorization * Work proactively with insurance carriers to ensure ... that all of the required information for payment has been received in a timely fashion. * Communicate and advise the clinical team on any changes in insurance companies reimbursement practices related to the authorization of process. * Ensure submissions are… more
- Providence (Missoula, MT)
- …use of hospital resources. The position is responsible for patient pre - certification according to departmental and interdepartmental policies and procedures ... while adhering to the patient focused admission process. The Quality Management Reviewer demonstrates job related skills in a safe, appropriate, effective and timely manner. Promotes a safe environment of care, to reduce risks and maintain safety in the work… more
- Northwell Health (Staten Island, NY)
- …and interacts with third party payers to obtain approval of hospital days, pre - certification and post-discharge eligibility in relation to clinical course + ... Ensures compliance with current state, federal, and third party payer regulations + Documents the case management process in the medical record; completes and documents a care coordination assessment on the patient + Serves as a liaison to patient, family,… more
- Catholic Health Initiatives (Omaha, NE)
- …for answering phone calls and scheduling patient appointments. + Conduct patient pre - certification to ensure coverage for appointments and medical care. + ... Schedule tests, procedures, and referral appointments. + Communicate with patients regarding appointments and instructions for procedures and tests + Collect insurance information and patient personal data. + May collect fees such as co-pays / co-insurance.… more