- Geisinger (Scranton, PA)
- …a tool to ensure that patients meet appropriateness of the setting. Actively involves payer liaison role in any case that has potential of not meeting medical ... necessity guidelines. Supports payer liaison role to resolve barriers through appropriate administrative...appropriate administrative and medical channels to avoid third party payer denials. Maintains awareness of all concurrent denials through… more
- Agendia, Inc (Irvine, CA)
- …policies of payors and work them in priority dependent on allotted timeframes per payer as the time can vary. *Contacts ordering physician's office to obtain missing ... *Previous medical billing experience preferred *Ability to read and understand medical payer policies as well as pathology reports *Ability to work with sensitive… more
- Accessia Health (Midlothian, VA)
- …benefit managers to identify and verify patient insurance coverage Identify payer coverage restrictions while maintaining high quality customer service standards in ... compliance with federal and state regulations Maintain a repository of payer coverage information or case studies Proactively update patient-related information to… more
- Reveal Health Tech (New York, NY)
- …documentation, and solution validation. Solid understanding of healthcare operations, payer /provider systems, and terminology. Proficiency in data analysis and ... (EHR) systems Medical coding standards such as FHIR, ICD, CPT Medicare/Medicaid data ( payer and/or provider side) UX Design principles and tools like Figma Web… more
- CoxHealth (Lake Spring, MO)
- …records, reviewing hospital charges and documentation to ensure compliance with payer regulations, coding conventions, and hospital policies. RN auditors are also ... responsible for educating employees, physician, and patients and others for billing compliance.Education: ▪ Required: Graduate of an accredited nursing program ▪ Preferred: Bachelor's Degree in Nursing Experience: ▪ Required: 2 years' related experience… more
- Providence Little Company of Mary Medical Center San Pedro-… (San Pedro, CA)
- …planning and transitions. Supports utilization management and ensures compliance with payer guidelines. Onboarding typically takes 2-4 weeks based on documentation ... and clearance processes. Requirements Required for Onboarding: Active RN License BLS Client Details City San Pedro State CA Zip Code 90731 more
- Boston Consulting Group (Boston, MA)
- …the health care (HC) industry including the biopharmaceutical, medical technology, payer , provider, health care services, and global health sectors. Strategy ... development, planning and operating model formalization for the practice Together with Regional Leadership team - develop annual plan, set priorities, and guide implementation/ tracking of progress Business development and execution support: Establish ongoing,… more
- Sandoz Group AG (Princeton, NJ)
- …analysis, framework, and process to evaluate WAC/NET pricing, payer reimbursement, and contracting/discounting strategies for Sandoz Biopharmaceuticals current ... and pipeline products *Enhance and contribute to organizational understanding of market dynamics, risks and competitor behaviors and impact of business segment (WHS, GPO, Clinics, Hospitals, Payers) decisions and actions influence the commercialization of… more
- PharmaCord (Jeffersonville, IN)
- …in obtaining coverage Leverages electronic tools to identify benefits and payer coverage; completes manual benefit investigation as needed Identifies and ... communicates patient's plan benefit coverage including the need for prior authorization, appeal, tier exception, and/or formulary exclusions Uses electronic resources to obtain benefit coverage outcome and if needed, outbound call to payers and HCPs to follow… more
- Massachusetts Psychological Association (Wellesley, MA)
- …and *Knowledge of CPT codes and experience with Massachusetts health plan payer reimbursement policies Travel Requirements: The DPA will attend an annual 4-day ... trip in DC for the APA State Leadership Conference and will be required to attend periodic meetings in Boston with legislators/regulators and the Massachusetts Mental Health Coalition. more
- Bryan Health (Lincoln, NE)
- …*Maintains awareness of financial reimbursement methodology, utilization management, payer /reimbursement practices and regulations and participates in resource ... stewardship. *Promotes quality improvement initiatives and health care outcomes based on currently accepted clinical practice guidelines and total quality improvement initiatives. EDUCATION AND EXPERIENCE: Current Registered Nurse licensure from the State of… more
- HirefinderRPO (Anchorage, AK)
- …in the Board State Practice Act and governmental and third party payer requirements. Record treatment changes per policy and procedures. Instruct patient's families ... or nursing staff in maintenance program and caregiver training in preparation for discharge from therapy services. Participate in discharge planning. Act as a clinical preceptor for affiliating CFY/RFP Speech-Language Pathologist and student programs. Comply… more
- Boost Home Health (Frisco, TX)
- …patient cases to confirm documentation meets all regulatory and third-party payer requirements; complete audits and billing in compliance with Medicare regulations. ... Supervise team members in line with company policies, contributing to interviewing, hiring, and ongoing staff development. Evaluate clinician performance, provide coaching, and recommend in-service training as necessary for continuous improvement. Lead QA/PI… more
- NORTH RANGE BEHAVIORAL HEALTH (Greeley, CO)
- …agencies. Administrative Support: Maintain accurate records, align services with payer requirements, and support billing processes. Qualifications: A High School ... Diploma or GED is required. Bilingual Skills (English/Spanish) desired Medication Aide Certification is highly desired, although training can be completed post-hire. CPR certification/first aid training within the first 6 months of employment A Valid Driver's… more
- Lucile Packard Children's Hospital (Palo Alto, CA)
- …the individual treatment plan that comply with LPCHS standards and payer requirements. Provides needed psychiatric diagnosis and other clinical information to ... submit claims to third party payers Involves child and adult protective services and law enforcement according to established legal reporting mandates. Coordinates with other providers and systems such as primary care providers, schools, community mental… more
- Medtronic (CA)
- …a complex, ever-changing environment. **Position Summary** Medtronic is seeking a US Payer Advocacy and Market Access Principal Specialist, a role responsible for ... This work requires in-depth, direct experience and expertise with commercial payer stakeholders, understanding how medical policies for innovative therapies are… more
- Rush University Medical Center (Chicago, IL)
- …depending on the circumstances of each case. **Summary:** The Manager, Revenue Cycle Payer Relations is responsible for oversight of payer performance. The ... of data and project related work as it pertains to payer performance, payer claim resolution projects, Joint Executive Committee meetings, and the overall… more
- Abbott (Abbott Park, IL)
- …are in search of experienced candidates with market access experience in payer value proposition development and management and patient support program (PSP) ... please take a look at qualifications below. The Sr. Director, Market Access - Payer Value & Access Strategies is a transformative leader within Abbott Diabetes Care… more
- Bausch + Lomb (Bridgewater, NJ)
- …the advancement of eye health in the future. **Overview** The **Senior Manager, Payer Marketing** role supports the market access strategic marketing efforts for the ... coverage objectives and profitable access. The position reports to the Director, Payer Marketing & Strategy and requires strong teamwork across Brand Marketing,… more
- CommonSpirit Health (Englewood, CO)
- …Central time zone. Do you enjoy special projects on the more technical side of payer analytics and managed care? The person in this role will need to be very ... side of our contract modeling system. The Senior Analyst, Payer Economics performs complex managed care payer ...Analyst, Payer Economics performs complex managed care payer financial analysis, strategic pricing and payer … more
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