Makes decisions supported by policy based on confidential financial information.
Utilizes scheduling and registration information to verify coverage and authorization.
Acts as a liaison between the patients, physicians, patient clinics, case management, centralized billing office, third party Medicaid eligibility vendor and community agencies.
CommonSpirit Health has more than 700 care sites across the U.S. from clinics and hospitals to home-based care and virtual care services. They are 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.
Accurate coding of professional services from medical record documentation.
Reviews, codes and assigns correct ICD-10-CM diagnosis codes.
Knowledge of insurance company, third-party and government reimbursement programs.
University Health (UH) is committed to being a leader in providing healthcare. UH is an equal opportunity employer committed to a culturally inclusive workplace that values and celebrates differences.
Promptly and accurately record all provider information.
Monitor status of payer applications to ensure completion.
Initiate and follow through on all aspects of provider credentialing.
UnityPoint Health is committed to team members and is 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 employees with support and development opportunities.
Reviews pre-admissions for correct classification and admission order.
Performs Utilization Review for each patient on their assigned daily census using established medical necessity guidelines.
Communicates with payers regarding authorization and medical necessity, utilizing excellent negotiating skills.
Oregon Health & Science University values a diverse and culturally competent workforce. They are an equal opportunity, affirmative action organization that does not discriminate against applicants.
Reaches out to members telephonically to assist with referrals, authorizations, HHC, DME needs, medication refills, make provider appointments and follow ups, etc.
Creates cases, tasks, and completes assessments in Case Management module for all Hospital and SNF discharges
Works as a team with the Case Manager to engage and manage a panel of SNP members
Alignment Health is breaking the mold in conventional health care, committed to serving seniors and those who need it most. We have built a team of talented and experienced people who are passionate about transforming the lives of the seniors we serve.
Receive and resolve patient correspondence regarding insurance billing.
Answer all correspondence relating to billing questions.
Verify insurance status, eligibility and general account information.
MANA Administration provides support services for 27 physician-owned medical practices in Northwest Arkansas. Their Administrative team are independent and work together, to help their physicians and clinics provide compassionate, comprehensive, quality health care while maintaining a healthy work-life balance.
Contacts insurance companies to determine pre-certification requirements.
Obtains pre-authorization prior to the scheduled complex service.
Liaisons with physicians to obtain additional information.
Piedmont Healthcare is a company focused on healthcare services. They appear to be a large corporate entity, offering a range of opportunities within the revenue cycle and healthcare sectors.
Accurately review denied claims to identify root causes.
Communicate directly with insurance representatives to negotiate settlements.
Monitor denial trends and provide actionable feedback to billing and clinical teams.
Mindoula is a healthcare organization. They are seeking an Account Receivable Representative and value candidates with strong communication and problem-solving skills.
Take inbound calls from patients, providers and members
Support members with their insurance needs, questions or concerns
Answer inquiries on benefit claims, appeals, and authorizations
Carenet Health pioneers advancements for an experience that touches all points across the healthcare consumer journey. They interact with 1 in 3 Americans every day, delivering positive healthcare experiences and improving outcomes.
Perform pre-call analysis and check the status by calling the payer or using IVR or web portal services.
Maintain adequate documentation on the client software to send the necessary documentation to insurance companies and maintain a clear audit trail for future reference.
Record after-call actions and perform post-call analysis for the claim follow-up.
TruBridge connects providers, patients, and communities with innovative solutions that create real value by supporting both the financial and clinical sides of healthcare delivery. They are a remote team that encourages their employees to push boundaries and look at things differently.
Review encounter documentation to confirm reported services.
Resolve pre-bill edits to confirm correct coding (modifier, diagnosis, CPT, and HCPCS review).
Educate providers on correct coding and documentation guidelines.
Northwestern Medicine is committed to prioritizing every patient interaction to cultivate a positive workplace. Because of its patient-first approach, the company stands as a leader in the healthcare industry with competitive benefits that take care of its employees.
Receiving phone calls and fax requests to schedule patients for outpatient tests.
Completing pre-registration of scheduled patients.
Ensuring a valid provider order is obtained.
CommonSpirit is a healthcare organization with more than 700 care sites across the U.S. They are committed to building healthy communities and advocating for those who are poor and vulnerable.
Research and interpret payer policies in accordance with healthcare coding and regulatory requirements.
Identify common error areas that can be made into automated software logics that prevent overpayments.
Develop claims editing logics that promote payment accuracy and transparency across lines of business.
Rialtic is an enterprise software platform empowering health insurers and healthcare providers to run their most critical business functions. Founded in 2020 and backed by leading investors, they are tackling a $1 trillion problem to reduce costs, increase efficiency and improve quality of care.
Manage multiple channel interactions professionally and efficiently.
Effectively present products/services to providers with integrity, understanding, and accuracy.
Focus on provider retention through first call resolution and maintain positive relationships.
Capital Blue Cross promises to go the extra mile for its team and community. Employees consistently vote it one of the “Best Places to Work in PA”, valuing professional/personal growth by investing heavily in training and continuing education.
Manages the entire lifecycle of payer enrollment, credentialing, and re-enrollment of healthcare providers and facilities.
Maintains provider databases, ensuring accurate, timely submission of documentation to secure billing privileges and network participation.
Resolves claim denials, verifying insurance and performing billing related tasks to ensure timely and accurate reimbursement.
Plumas District Hospital (PDH) provides compassionate care with exceptional customer service. They are located in Quincy, California with a team that puts community first.
Maintain individual provider files to include up to date information needed to complete the required governmental and commercial payer credentialing applications.
Maintain accurate provider profiles on CAQH, NPPES and any other applicable profiles
Complete credentialing applications to add current and new providers to commercial, Medicaid, and Medicare payers
Expressable is a virtual speech therapy practice with a mission to transform care delivery and expand access to high-quality services. They are passionate advocates of parent-focused intervention, serving thousands of clients since their inception in late 2019.
Performs Current Procedural Terminology (CPT) and International Classification of Diseases, volume 10 (ICD10) coding through abstraction of the medical record.
Trains physicians and other staff regarding documentation, billing and coding, and performs various administrative and clerical duties to support the roles core function.
Acts as a key collaborator with Providers and Clinical areas to ensure the medical record accurately reflects the patient's service.
At Northwestern Medicine, every patient interaction makes a difference in cultivating a positive workplace. As an integral part of their team, you'll have the opportunity to join their quest for better health care, no matter where you work within the Northwestern Medicine system.
Receive and respond to prescription refill requests through various communication channels.
Verify the validity and accuracy of prescription refill requests received, ensuring compliance with regulatory guidelines.
Prepare and dispense prescription refills accurately and efficiently, following established organizational protocols and procedures.
Carenet Health pioneers advancements for an experience that touches all points across the healthcare consumer journey. Interacting with 1 in 3 Americans every day, it delivers positive healthcare experiences and improves outcomes.
Strengthening the connection between the patient and their primary care physician/medical practice staff, as well as improving the patient’s health and well-being.
Engaging patients and helping them navigate their care, solve their healthcare issues, and improves communication with their medical practice.
Assisting the patient in achieving better health outcomes by addressing their questions and concerns, connecting them with the medical practice.
Guidehealth is a data-powered, performance-driven healthcare company dedicated to operational excellence. Their goal is to make great healthcare affordable, improve the health of patients, and restore the fulfillment of practicing medicine for providers.
Conduct insurance verification for new referrals and ongoing patients.
Initiate and obtain prior authorizations for home health services.
Maintain insurance, authorization, and eligibility information in real-time.
VitalCaring is a leading provider of home health and hospice services. Founded in 2021, they have over 65 locations across the country and are committed to fostering a culture of support, growth, and excellence for their team, ensuring exceptional patient care.