- 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
- 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 Remote PRN Clinical Utilization Review Specialist is responsible for evaluating the necessity, appropriateness, and efficiency of hospital… 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
- Tenet Healthcare (Detroit, MI)
- Rehab Care Coordination Specialist Full Time Days - 2506003435 Description : DMC Rehabilitation Institute of Michigan is one of the nation's largest hospitals ... skills to effectively resolve conflict. Promotes a positive customer relations environment. Coordinates the utilization review function for assigned patients.… 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
- Emory Healthcare/Emory University (Peachtree City, GA)
- …level of interaction with facilities and clients. Enhance and expand client relations with facilities and their staff. + Evaluate and develop patients' plans ... accurate documents of each patient's evaluation and progress letters to physicians and payer sources, case managers, etc. as indicated appropriately and in a timely… more
- PruittHealth (Norcross, GA)
- …and educate on the requirements of credentialing and re-credentialing. * Support the Payer Relations with reports and updates regarding participation status with ... all payers. * Maintain corporate standard time frame for completion of credentialing applications. * Perform special projects upon request * Excellent Communication, Customer Service and Time Management Skills * Handles any additional duties as assigned by… more
- Nuvance Health (Danbury, CT)
- …organizational and record keeping skills. Company: Nuvance Health Org Unit: 1784 Department: Payer Relations Exempt: No Salary Range: $20.86 - $38.73 Hourly We ... that provider rosters and locations are current. Responsible for reporting payer credentialing status to WCHN management. Makes suggestions for enhancements/changes… more
- Avera (Sioux Falls, SD)
- …and compliance. The analyst collaborates with clinical, billing, coding, IT, and payer relations teams to identify trends, resolve discrepancies, and drive ... accuracy and adherence to contract terms. + Partner with clinical, operational, and payer relations teams to resolve discrepancies and improve documentation. +… more
- HCA Healthcare (Nashville, TN)
- …support to various teams, including payer contracting and analytical teams, payer relations , managed care, legal support, and service line leaders. Your ... best practices when collaborating with customers and peers. + Assist the Payor Relations Managed Care teams and Managed Care Legal teams in proactively preparing for… more
- Catholic Health Services (Melville, NY)
- …other patient access operational activities for the Catholic Health. The Authorization Specialist role is responsible to submit prior authorizations timely, and that ... required clinical criteria is complete and accurate according to payer requirements. The role will work closely with Utilization Management, Patient Accounts, and… more
- Sharp HealthCare (San Diego, CA)
- …and Hospital goals.Assists Team Leader with staff development in customer relations by increasing employee awareness when areas for improvement are observed. ... management.* Communicate with appropriate clinical staff the status of ongoing payer requests, denials and/or potential denials for non-covered services and other… more
- Ventura County (Ventura, CA)
- …strong Inpatient and Outpatient coding experience and Certified Coding Specialist certification combined with extensive supervisory experience overseeing other ... Coders (Inpatient & Outpatient), coding productivity and collaborate with Clinical Documentation Specialist team; + Provides coding guidance to staff on the most… more
- Gentiva (Jacksonville, FL)
- …admissions within the company's 3-hour commitment window + Verify insurance benefits, payer source, and secure authorizations for hospice care + Communicate pending ... in customer service + Strong skills in communication, organization, negotiation, public relations , and data entry + Familiarity with Microsoft Office and healthcare… more
- Johns Hopkins University (Baltimore, MD)
- …accurate registration, insurance referral and preauthorization requirements, patient relations and satisfaction, clinical regulatory compliance, and program ... management). + Educate providers and clinic staff regarding third-party payer requirements, managed care contracts, and billing/documentation requirements. + Provide… more
- Penn Medicine (East Petersburg, PA)
- …with External Providers. Ensures compliance with hospital policies, billing guidelines, and payer policies. + Qualified individuals must have the ability with or ... preparing medical records and providing appropriate clinical information to the specialist . Communicating appointment information and expectations with patients in a… more