- Northwestern Mutual (Franklin, WI)
- …Provides technical expertise for assigned product line(s) in the handling of complex , contestable, sensitive and large benefit amount claims. Primary Duties & ... expertise to applicable product line claims division in the handling of complex , contestable, sensitive and large benefit amount claims. This includes responsibility… more
- Huron Consulting Group (Chicago, IL)
- …strategies and achieve measurable clinical and financial improvements. As a Management Consultant , you will work with a team of technical and project management ... consultant to support integrated initiatives that optimize Epic systems,...client stakeholders to deliver innovative, data-driven solutions that address complex digital challenges. Your role will be pivotal in… more
- Waystar (Atlanta, GA)
- **ABOUT THIS POSITION** This Senior Consultant , Enterprise Rule & Edits position reports to our Enterprise Rules & Edits Manager and has the responsibility for ... active involvement in scoping, project planning, implementation, and stabilization. The Consultant will leverage billing and coding subject matter expertise and… more
- Virginia Mason Franciscan Health (Burien, WA)
- …department chairs as necessary * Provide consultation to Care Coordination staff regarding complex clinical issues and advises on next steps * Documents patient care ... and champion successful relationships with Care Coordination (Utilization Management, Denials Management, and Progression/Transition of Care) * Establish partnership… more
- Nuvance Health (Danbury, CT)
- …approach to physician advisor roles in utilization management, , documentation and denials /downgrades. * Serves as physician expert and provides support to care team ... denial management issues, and potentially quality issues. * Functions as a consultant and resource to other Physician Advisors and primary (attending) physicians. *… more
- Houston Methodist (Houston, TX)
- …alternative levels of care. Provide consultation to case management staff regarding complex clinical issues and advises on next steps. Provide feedback to attending ... in department meetings. **QUALITY/SAFETY ESSENTIAL FUNCTIONS** + Act as consultant and resource to attending/responsible physicians regarding their decisions… more
- HCA Healthcare (Conroe, TX)
- …the medical staff and medical staff affairs. + Serves as a consultant to hospital Medical Staff Services regarding physician credentialing, utilization, and quality ... technologies and programs to HCA hospitals. + Serves as a resource and consultant to the Vice President Physician Services Group and/or Vice President Business… more
- MyFlorida (Bunnell, FL)
- …and must balance receipts daily. This position maintains a variety of complex accounting and financial records in Accounts Receivable reporting. This position also ... State and Federal programs. The position reports directly to Operations Management Consultant 1. Audits, analyzes and reviews encounters and verifies all insurance… more
- Blue Cross and Blue Shield of Minnesota (Eagan, MN)
- …fast-paced, detail-oriented, and highly collaborative. The analyst begins by navigating complex data requests-balancing urgent consultant inquiries with ongoing ... with coworkers and internal business partners to clarify requirements, analyze complex data, and produce and present meaningful and defensible results, including… more
- Henry Ford Health System (Troy, MI)
- …and facilitation of multi-disciplinary, team-based root cause analysis of edits and denials . TF Consultant should utilize knowledge of Epic optimization to ... GENERAL SUMMARY: The Transaction Flow (TF) Consultant is responsible for leading and supporting teams...of services - from primary and preventative care to complex and specialty care, health insurance, a full suite… more
- State of Connecticut, Department of Administrative Services (East Hartford, CT)
- …conducting second level review of cases and case referral to a physician consultant for final disposition; + Perform related duties as assigned; DDS Mission ... appeals on behalf of a facility relative to intermediate denials ; + May testify in court; + May coordinate...review of cases and case referral to a physician consultant for final disposition; + Performs related duties as… more
