Accountable for making decisions supported by policy based on confidential financial information both from the facility and from patients to determine qualification for CICP, Charity programs, or payment arrangements.
Verify coverage and authorization for all scheduled procedures through scheduling and registration information.
Act as a liaison between the patients, physicians, patient clinics, case management, centralized billing office, third party Medicaid eligibility vendor and community agencies.
CommonSpirit is accessible to nearly one out of every four U.S. residents. With our combined resources CommonSpirit is committed to building healthy communities advocating for those who are poor and vulnerable and innovating how and where healing can happen both inside our hospitals and out in the community.
Coordinating staffing and workload for the financial clearance process.
Verifying eligibility, benefits, referral, and authorization requirements.
Serving as a liaison between patient, referring physician, and insurance plan.
UnityPoint Health is committed to team members and has been recognized as a Top 150 Place to Work in Healthcare by Becker's Healthcare. They champion a culture of belonging where everyone feels valued and respected, and provide support and development opportunities.
Showcase customer service and data entry skills as part of the healthcare team.
Involved in claims adjudication and/or provider credentialing.
Support customers by phone, email and chat.
Sutherland helps customers globally achieve greater agility and transform automated customer experiences. As a digital transformation company they have been in business for over 35 years and are Great Place to Work certified with nearly 40,000 employees.
Support clinical staff by gathering data to complete the medical necessity review process.
Create and send letters to providers and/or members to communicate information.
Collaborate with care management teams and stakeholders to provide optimal service.
Wellmark is a mutual insurance company owned by policy holders across Iowa and South Dakota, and they’ve built their reputation on over 80 years’ worth of trust. They are motivated by the well-being of their members, putting them first and committing to sustainability and innovation.
Responsible for economic credentialing and provider enrollment with contracted managed care and governmental plans.
Communicating provider participation information to internal and external customers.
Ensures compliance with regulatory agencies and maintains a working knowledge of statues and laws.
The West Virginia University Health System is West Virginia’s largest health system and the state’s largest employer. They have more than 3,400 licensed beds, 4,600 providers, 35,000 employees, and $7 billion in total operating revenues.
Manage fax and mail intake, process medical records requests, and complete insurance pre-authorizations.
Strengthen the operational foundation of our fast-growing digital sleep clinic by handling documentation and correspondence.
Collaborate closely with cross-functional teams in a tech-enabled care environment, contributing to accessible sleep health.
Dreem Health, managed by the Sunrise Group, is America's leading digital sleep clinic that's fixing the broken sleep care patient journey. They connect patients with sleep specialists through a straightforward telehealth platform, eliminating lengthy wait times and complicated in-lab testing.
Translates patients’ medical records into standardized codes for diagnoses and treatments.
Ensures compliance with legal, regulatory, and organizational standards.
Manages records to ensures claims are processed correctly and on time.
Dignity Health Medical Foundation, established in 1993, is a California nonprofit public benefit corporation with care centers throughout California. They are an affiliate of Dignity Health - one of the largest health systems in the nation - with hospitals and care centers in California, Arizona and Nevada.
Auditing incoming applications to ensure all required information is documented.
Handling multiple applications simultaneously with using BPM, Cactus, CAQH, and Facets.
Communicating effectively with providers and internal teams to resolve any issues and ensure smooth operations.
BlueCross BlueShield of Tennessee has been helping Tennesseans find their own unique paths to good health since 1945. At BCBST, they empower their employees to thrive both independently and collaboratively, creating a collective impact on the lives of their members.
Review payer PA policy documents for specialty medications and interpret coverage criteria.
Translate policy language into standardized, structured data fields.
Flag ambiguous, conflicting, or unclear policy language.
Quantile Health is a New York-based AI startup focused on expanding patient access to medicines and cutting commercial research costs for the life science industry. They are a fast-growing company using AI agents.
Ensures payments for pharmacy partners are retrieved and posted accurately and timely.
Resolves missing remittance files and any unmatched/unreconciled remittance detail.
Contributes to the month-end reporting process by retrieving necessary reporting related to payment activity.
Shields Health Solutions partners with hospitals to build and manage specialty pharmacies. They focus on improving medication access, adherence, and outcomes for patients with chronic illnesses. The company is fast-growing in the Healthcare Services sector and values teamwork and high-quality work.
Prepares and submits clean claims to various insurance companies.
Identifies and resolves patient billing complaints.
Performs various collection actions including contacting patients by phone.
SelectQuote provides solutions that help consumers protect their most valuable assets: their families, health and property. SelectRX, a subsidiary of SelectQuote, is prioritizing important population health initiatives focused on actively managed, high-touch patient experience.
Responsible for managed care, insurance verification and patient price estimate processes.
Supports ambulatory practices, professional services and hospital departments.
Works closely with internal and external customers to ensure patients receive optimal financial services related to their care.
Oregon Health & Science University values a diverse and culturally competent workforce. They are proud of their commitment to being an equal opportunity, affirmative action organization that does not discriminate against applicants on the basis of any protected class status, including disability status and protected veteran status.
Responsible for serving as front-line support for the Patient Connection Center within Piedmont Healthcare.
The Patient Connection Associate III is responsible for pre-registering and scheduling moderately complex procedures.
Coordinating multiple resources for patient services.
Piedmont Healthcare is responsible for pre-registering and scheduling moderately complex procedures and coordinating multiple resources for patient services. The company offer opportunities to those who seek to be challenged and have a meaningful impact on the health of our patients and community.
Prepare and submit credentialing and enrollment packets.
Maintain accurate provider files and track expirations.
Provide assistance to the billing team during staff absences.
Modena Health and Modena Allergy & Asthma are leading medical practices specializing in allergy, asthma, and immunology care, with clinics across Southern California and Arizona and plans for national expansion. They are physician-led and technology-enabled, committed to transforming allergy care while advancing clinical research and expanding access to cutting-edge medicine.
Provide high-level customer service to patients and fellow employees.
Review and update billing, codes, and account information.
Ensure accurate billing for all services provided, adhering to compliance.
Hanger, Inc. is the world's premier provider of orthotic and prosthetic (O&P) services and products. With 160 years of clinical excellence, Hanger's vision is to lead the orthotic and prosthetic markets by providing superior patient care, outcomes, services and value.
Manage prior authorizations and related administrative paperwork.
Input patient information, medical records (CPT, ICD-10, HCPCS), and billing data into EMR/EHR systems.
Assist with processing insurance claims, verifying patient insurance information, and handling billing inquiries, concerns, and documentation.
Wing is redefining the future of work for companies worldwide. They aim to be a one-stop shop for companies looking to build world-class teams and place their operations on autopilot.
Directly communicate with insurance companies to facilitate the approval of medications.
Navigate pharmacy operating systems to input data and prepare action plans for follow-up.
Communicate directly with patients over the phone to assist them in medication compliance.
Shields Health Solutions provides integrated pharmacy solutions. They partner with hospitals and health systems to improve patient outcomes and create financial value.
Appeal denied claims through Redetermination, Reconsideration, or Administrative Law Judge processes, following laws.
Proactively investigate patient charts by reading documents and conduct computer-based research.
Solventum is a new healthcare company with a history of tackling major challenges to improve lives and support healthcare professionals. They focus on innovative solutions at the intersection of health, material, and data science and are guided by empathy and clinical intelligence.
Determines accurate CPT, HCPCS procedure and professional supply codes and ICD-10-CM diagnosis codes.
Performs activities related to physician practice management and coding.
Provides training and education on coding and compliance issues to physicians, non-physician providers and staff.
Ohio State University Physicians is dedicated to providing exceptional patient care while fostering a collaborative work environment. The buckeye team includes more than 1,800 nurses, medical assistants, physicians, advanced practice providers, administrative support staff, IT specialists, financial specialists and leaders.