Assists with medical record documentation requests and leverages medical management system to initiate case and/or authorization to support clinical processes.
Conducts fax and telephonic outreach; and written communications to members and/or providers to communicate status of UM/CM processes.
Actively participates in supporting department compliance and performance through administrative activities such as report monitoring/distribution, and other tasks as assigned by leadership.
Provide general medical office administrative support.
Answer telephone calls and take and route messages.
Interface with physicians and patients.
Stony Brook Surgical Associates, UFPC supports the operation of the hospital and provision of health care and is the co-employer as is necessary to conduct its responsibilities.
Be the primary point of contact for all providers.
Provide professional, accurate and timely responses to all provider inquiries.
Maintain a current knowledge of all contract requirements and objectives.
Machinify is a leading healthcare intelligence company with expertise across the payment continuum, delivering unmatched value, transparency, and efficiency to health plans.
Processes acute and post-acute inpatient medical or behavioral health and select intensive outpatient higher level of care requests through review of the submitted request and applicable clinical records
Collaborates with UM department staff, including Clinical Support Specialists and Medical Directors to make a final determination, and with Care Management staff on discharge planning and transition of care activities.
Identifies and refers members with complex needs to the appropriate population health and/or care management program.
Capital Blue Cross promises to go the extra mile for our team and our community. Our employees consistently vote us one of the “Best Places to Work in PA, and we foster a flexible environment where your health and wellbeing are prioritized.
Manages client denials and concerns through analytic review of clinical documentation.
Delivers final determination based on skillsets and partnerships with Humana parties.
Investigates and resolves member and practitioner issues via phone or face to face to support quality goals.
Humana Inc. is committed to putting health first for teammates, customers, and the company. Through Humana insurance services and CenterWell healthcare services, they strive to make it easier for millions to achieve their best health, delivering needed care and service.
Request, receive, process, and track medical and billing records from healthcare providers. Organize, scan, upload, and maintain medical and legal documents within designated firm systems. Review and verify medical records and billing statements for accuracy, completeness, and consistency.
Keller Postman represents a broad array of clients in class and mass actions, individual arbitrations, and multidistrict litigation matters.
Lead the preparation and submission of comprehensive provider rosters to Managed Medicare, Medicaid, and commercial payers.
Audit internal provider data against database records to ensure 100% accuracy before submission.
Serve as the primary point of contact for health plans to resolve roster discrepancies, rejections, or paneling delays.
Privia Health is a technology-driven, national physician enablement company that collaborates with medical groups, health plans, and health systems. The Privia Platform consists of scalable operations and end-to-end, cloud-based technology that reduces unnecessary healthcare costs.
Process transactions on insurance accounts and interact with insurance companies.
Communicate with staff and third-party customers to ensure accurate processing.
Prioritize accounts to maximize aged AR resolution, and research documentation.
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.
Answer high volume of incoming calls and place outbound calls, responding to patient inquiries related to healthcare services. Act as primary point of contact for patients via phone, email and chat systems. Convert calls to scheduled appointments for CHOICE clinics.
CHOICE is the largest provider of pediatric dental care in the Southwest United States, and we pride ourselves on delivering high quality care to children in our communities.
Coordinate care between VA and community providers.
Schedule appointments and coordinate care.
Process administrative notes for consults.
CVP is an award-winning healthcare and next-gen technology and consulting services firm solving critical problems for healthcare, national security, and public sector clients.
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. Comply with all reimbursement and billing procedures for regulatory, third party, and insurance compliance norms.
You’ll help connect providers, patients and communities with innovative solutions that create real value by supporting both the financial and clinical sides.
Work primarily remotely with the patient’s medical practice staff and Guidehealth’s Case Management team to manage a targeted population of patients.
Assist patients in achieving better health outcomes by addressing their questions, connecting them with the medical practice, and implementing high-impact care plans.
Document patients’ medical history and medical issues accurately in the electronic health record (EHR).
Guidehealth is a data-powered, performance-driven healthcare company dedicated to operational excellence, making great healthcare affordable and improving patient health.
Make outbound calls to schedule appointments for preventative health screenings. Assist members and patients with benefits and insurance information. Conduct surveys and make a difference in someone’s life!
Carenet Health has pioneered advancements for an experience that touches all points across the healthcare consumer journey.
Acts as key point of contact for the processing of enrollment applications for all providers. Works with System Credentialing and local medical staff contacts. Responsible for completing the ongoing review and attestation of all Munson Healthcare provider enrollment records.
Munson Healthcare is northern Michigan’s largest healthcare system, with eight award-winning community hospitals serving over half a million residents.
Support patients through the denial and appeal process.
Coordinate with healthcare providers and insurance companies.
Ensure seamless access to our innovative DME device.
Noctrix Health is redefining the treatment of chronic neurological disorders with clinically validated therapeutic wearables. Their team is dedicated to delivering prescription-grade therapy with an outstanding user experience and has pioneered the world’s first drug-free wearable therapy.
Conducting first phone calls with new members to assess fit for Brightline services
Scheduling appointments for members
Ensuring member paperwork has been completed
Brightline is a therapy and psychiatry practice that delivers expert pediatric, teen, and parental mental health care to families and kids up to age 18.
Ensure adherence to payer requirements and internal compliance standards.
Support audit readiness, reduce denials, and improve claim resolution.
Maintain payer setup and readiness including fee schedules.
Expressable is a virtual speech therapy practice on a mission to transform care delivery and expand access to high-quality services, serving thousands of clients.
Responsible for accurately and respectfully responding to inquiries from employees/members, providers and clients in a high volume call center.
Seamlessly navigate multiple system applications/screens and resources to accurately respond to inquiries.
Thoroughly and accurately document all inquiries and actions taken using applicable software applications.
Luminare Health helps clients and brokers design custom self-funded healthcare plans providing innovative solutions, flexibility, complete data transparency, and member-centered support. They rely on their decades of industry experience and proven, data-driven results to deliver optimal benefits solutions, customized to meet our clients’ needs.