Oversees day-to-day adjudication operations and ensures a compliant operational environment.
Establishes and maintains reports that support the efficacy of each service authorization process activity.
Monitors encounter data submissions for accuracy and maintains documentation and troubleshooting processes to support data quality.
Habitat Health provides personalized, coordinated clinical and social care as well as health plan coverage through the Program of All-Inclusive Care for the Elderly (“PACE”) in collaboration with our leading healthcare partners, including Kaiser Permanente. They are redefining aging in place and building engaged, fulfilled care teams to deliver personalized care.
Lead and manage a team of revenue cycle and/or eligibility specialists.
Serve as the primary subject matter expert for insurance eligibility verification and billing requirements.
Oversee day-to-day revenue cycle operations, including patient billing support and claim resolution.
Midi Health is focused on scaling billing operations. They have a fast-paced, growth-focused environment that supports teamwork and continuous improvement.
Secures prior authorizations for outpatient imaging and in-office scheduled services.
Acts as a liaison between the payer and clinic schedulers/medical support staff.
University of Utah Health enhances the health and well-being of people through patient care, research, and education. They seek staff committed to compassion, collaboration, innovation, responsibility, integrity, quality, and trust, with five hospitals and eleven clinics.
Oversee a team of Claims Analysts and outsourced vendor staff.
Ensure team meets quality, production, and service expectations.
Address complex claims and customer service inquiries.
Jobgether is a platform that uses AI-powered matching process to ensure applications are reviewed quickly and fairly. They identify top-fitting candidates and share the shortlist with the hiring company, while not replacing human judgement in the final hiring decisions.
Manage the full lifecycle of billing, collections, and eligibility verification to ensure accuracy and timely claims processing.
Monitor denial trends and underpayments to identify root causes; collaborate with the team to implement sophisticated, long-term solutions.
Update and own Standard Operating Procedures (SOPs) in partnership with the team to ensure our workflows remain efficient and scalable.
Ophelia is a healthcare startup that helps individuals with OUD by providing FDA-approved medication and clinical care through a telehealth platform. They are a team of physicians, scientists, entrepreneurs, researchers and White House advisors, backed by leading technology and healthcare investors working to re-imagine and re-build OUD treatment in America.
Conduct coverage reviews based on member plan benefits and policies.
Document clinical review findings, actions, and outcomes.
Communicate and collaborate with providers for benefit determinations.
Capital Blue Cross promises to go the extra mile for their team and community. They foster a flexible environment where health and wellbeing are prioritized and employees consistently vote it as one of the "Best Places to Work in PA."
Manage a team of Admissions Specialists, overseeing metrics, onboarding, meetings, and training.
Directly field inbound inquiries and, at times, manage your own caseload.
Collect and review data to inform coaching and feedback sessions, coordinating interdepartmentally to meet patient and family needs.
Equip is a virtual, evidence-based eating disorder treatment program aiming to ensure everyone can access effective treatment. Founded in 2019, Equip is a virtual company with a highly-engaged and diverse culture, recognized as one of the most influential companies of 2023.
Lead our Eligibility team to ensure our participants maintain eligibility for PACE services.
Proactively identify and mitigate risks pertaining to participant eligibility.
Oversee participant demographic, eligibility and enrollment data integrity across Welbe systems.
WelbeHealth's interdisciplinary team provides all-inclusive care to vulnerable seniors. The company is rapidly expanding and has an encouraging and loving environment where every person feels uniquely cared for.
Oversee the daily operations of a team or multiple teams.
Play a crucial part in achieving team quality and facilitating staff development.
Provide support and guidance on complex claims and customer service inquiries.
Jobgether uses an AI-powered matching process to ensure your application is reviewed quickly, objectively, and fairly against the role's core requirements. They identify the top-fitting candidates, and this shortlist is then shared directly with the hiring company.
Shapes vital subfunction with strategic leadership and operational oversight.
Builds scalable processes for accuracy, timeliness, and quality of authorizations.
Collaborates across functions for data discrepancies and continuous process improvement.
Habitat Health provides personalized, coordinated clinical and social care as well as health plan coverage through the Program of All-Inclusive Care for the Elderly (“PACE”) in collaboration with their leading healthcare partners, including Kaiser Permanente. They build engaged, fulfilled care teams to deliver personalized care in their centers and in the home.
Lead one of Rula’s most critical operational functions.
Own end-to-end credentialing and enrollment outcomes.
Partner across the company to ensure providers are credentialed and enrolled accurately, compliantly, and efficiently.
Rula is dedicated to treating the whole person, not just the symptoms and aim to create a world where mental health is no longer stigmatized or marginalized, but rather is embraced as an integral part of one's overall well-being. Rula is a remote-first company that values diversity, equity, and inclusion.
Process new patient referrals and accurately enter patient information.
Communicate with payors, referral sources, and patients regarding documentation and eligibility.
Verify eligibility and benefits in a timely manner and maintain active authorizations.
Immersiv is a new medical infusion clinic company designed to enhance the experiences of providers and patients as they navigate the healthcare system. They aim to offer more than just medication, also providing access to vaccines and outcomes assessments.
Serves as front line support for the Patient Connection Center.
Reviews orders for outpatient hospital services to ensure completeness prior to scheduling.
Prepares for the patient visit by verifying patient insurance, confirming benefits, determining authorization requirements, reviewing medical necessity, and creating patient liability estimates.
Piedmont Healthcare provides healthcare services. They are a corporate business unit, but employee count isn't specified.
Oversee client service and communication, ensuring excellence in every interaction.
Manage administrative processes for client insurance policies such as renewals and invoicing.
Work with underwriters to find creative solutions for customer needs and facilitate client claims processes.
Insurance Office of America (IOA) provides property and casualty, employee benefits, personal lines insurance, and risk management solutions, including insurtech innovation. The company, founded in 1988, has over 1,300 associates in over 60 offices in the U.S. and UK.
Responsible for review and analysis of underwriting data to expand and maintain a profitable book of business under direct supervision.
Manages agency relationships through continued customer service and supports marketing activities led by marketing manager.
Possess knowledge, critical analytical and strategic decision making skills to make independent underwriting decisions within letter of authority
Crum & Forster (C&F) provides specialty and standard commercial lines insurance products through our admitted and surplus lines insurance companies. They have more than 2000 employees and is increasingly winning recognition as a great place to work, earning several workplace and wellness awards.
Follows documented process to ensure timely processing of Primary Source Verification completion for initial and recredentialing.
Follows guidelines in alignment with all NCQA, CMS, and state requirements as related to the provider credentialing.
Works with both internal and external stakeholders to resolve complex provider credentialing issues.
Privia Health is a technology-driven, national physician enablement company that collaborates with medical groups, health plans, and health systems to optimize physician practices, improve patient experiences, and reward doctors for delivering high-value care in both in-person and virtual settings. The Privia Platform consists of scalable operations and end-to-end, cloud-based technology that reduces unnecessary healthcare costs, achieves better outcomes, and improves the health of patients and the well-being of providers
Evaluates certification requests by reviewing group specific requirements.
Triage the call to determine if a Utilization Review Nurse is needed.
Cottingham & Butler sells a promise to help clients through life’s toughest moments by hiring, training, and growing the best professionals. The company culture is guided by the theme of “better every day” constantly pushing themselves to be better than yesterday.
Serve as the Medicare coverage determinations and redeterminations subject matter expert.
Create and uphold robust policies and procedures for coverage determinations and redeterminations in accordance with CMS guidelines.
Recruit, onboard, train, and manage Medicare PA and Appeals pharmacists and technicians.
Judi Health provides a comprehensive suite of solutions for employers and health plans. Together with our clients, they’re rebuilding trust in healthcare in the U.S. and deploying the infrastructure we need for the care we deserve.
Supervise, direct and evaluate a diverse group of health care professionals to assure effectiveness of care coordination activities.
Develop audit plans and tools for teams to ensure compliance with state contracts on performance metrics and to ensure member needs are met.
Interview, hires, mentors, evaluates, coaches and manage performance for a diverse care coordination team.
Humana Inc. is committed to putting health first for its teammates, customers, and company. Through Humana insurance services and CenterWell healthcare services, they aim to make it easier for the millions of people they serve to achieve their best health.