Prepare complex prior authorization requests by identifying clinical guidelines for review.
Proactively obtain clinical information from prescribers to ensure all aspects of clinical guidelines are addressed.
Effectively use problem solving skills to identify gaps and resolve concerns.
Judi Health is an enterprise health technology company providing a comprehensive suite of solutions for employers and health plans. They offer full-service health benefit management solutions, and consolidate all claim administration-related workflows in one secure platform.
Responsible for the direct supervision of the centralized managed care activities.
Leads the team by recruiting, training, mentoring, and managing the work queues of direct reports.
Serves as the first line of communication with the practices/departments to answer questions and trouble shoot issues.
OHSU is Oregon's only public academic health center. In addition to caring for patients, they lead groundbreaking research and train the next generation of health care professionals. As Portland's largest employer, OHSU provides opportunities to learn and advance in a system of hospitals and clinics across Oregon and Southwest Washington.
Performs claims processing, insurance and charge verification, payment posting, account resolution, customer service and follow up.
Educates staff and physicians on CPT/HCPCS/ICD-10 codes and appropriate documentation requirements to reduce errors and remain compliant.
Works directly with staff when needed for insurance authorization assistance, IPA guidance and insurance optimization.
Community is committed to providing the highest standard of care. They value their diverse team members and offer various opportunities for growth and development.
Manage end-to-end case activities throughout the insurance verification and authorization process.
Serve as the single point of contact between the internal/external team, client, provider, payor, facility, and patient.
Provide support across multiple client programs, ensuring effective oversight, operational excellence, and consistent delivery of quality service.
PRO-spectus has created a culture that is supportive, dedicated, and teamwork driven. They celebrate each other’s joys in personal life and professional accomplishments, promoting meaningful relationships and friendships, with humility and compassion at our core.
Communicate with insurance companies to facilitate medication approvals.
Navigate pharmacy systems to input data and prepare action plans.
Communicate with patients and clinician offices regarding medication access.
Shields Health Solutions focuses on improving patient care by removing barriers to medication access. They value creating a positive and inclusive work environment where employees can grow their careers.
Accountable for making decisions supported by policy based on confidential financial information to determine qualification for CICP, Charity programs, or payment arrangements.
Verify coverage and authorization for all scheduled procedures using scheduling and registration information; populate price estimate tool to decide patient portion.
Act as a liaison between patients, physicians, patient clinics, case management, centralized billing office, third party Medicaid eligibility vendor and community agencies.
CommonSpirit has over 700 care sites across the U.S. from clinics and hospitals to home-based care and virtual care services and is accessible to nearly one out of every four U.S. residents. 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.
Enrolling practitioners in health plans in a timely and effective fashion.
Monitoring progress and ensuring timeliness of enrollment completion.
Maintaining provider enrollment goals for all divisions.
Pediatrix Medical Group provides specialized health care for women, babies, and children. Since 1979, Pediatrix has grown into a national, multispecialty medical group committed to coordinated, compassionate, and clinically excellent services.
Review incoming referral orders to assess patient’s needs based on diagnosis, insurance coverage or lack thereof, and previous treatments.
Verify patient information including demographics, insurance coverage and financial status; confirm patient eligibility for health care coverage and clarify any managed care arrangements.
Contact the patient prior to service to inform them of their estimate and collect any pre-payments at that time.
OHSU is Oregon's only public academic health center, caring for patients and leading groundbreaking research. As Portland's largest employer, they offer opportunities to learn and advance in a system of hospitals and clinics across Oregon and Southwest Washington.
Acts as initial service ambassador to referral sources, physicians, patients, caregivers and other external customers providing the highest quality service.
Responsible for the initial entry, verification, and maintenance of information regarding new patients in all applicable software programs.
Processes private insurance verifications, verifies eligibility of Medicare, Medicaid and third party payers and any other duties as directed.
CommonSpirit Health at Home is a full-service health care organization that believes the best place for someone to get better is in their own home. As a faith-based organization, they are committed to finding new ways to improve the health of their patients and the health of the communities they serve.
Understands organizational goals for timely account resolution.
Performs demographic and financial assessments.
Communicates patient's financial responsibility and requests payment.
Prisma Health is a not-for-profit health organization in South Carolina, serving more than 1.2 million patients annually. Their 32,000 team members are dedicated to supporting the health and well-being of the community.
Ensure coordination of provider invoice activities to support timely reimbursement.
Research and resolve claim denials that fail payer edits, preparing corrections and appeals.
Verify patient eligibility, benefits, and health‑plan information using payer databases.
CareCentrix supports value-based care by providing care management and transition of care services. They focus on improving patient outcomes and managing healthcare costs through a range of programs and services. The company values caring, doing the right things and striving for excellence.
Analyze and evaluate worker’s compensation claim payments using EnableComp’s proprietary software, systems and tools.
Research, request and acquire all pertinent medical records, implant manufacturer’s invoices and any other supporting documentation necessary and then submit with hospital claims to insurance companies to ensure prompt correct claims reimbursement.
Conduct timely and thorough telephone follow-up with payers to ensure claims with supporting documentation have been received and facilitate prompt reimbursement.
EnableComp provides Specialty Revenue Cycle Management solutions for healthcare organizations, leveraging over 24 years of industry-leading expertise and its unified E360 RCM ™ intelligent automation platform to improve financial sustainability. EnableComp is a multi-year recipient the Top Workplaces award and was recognized as Black Book's #1 Specialty Revenue Cycle Management Solution provider in 2024.
Coordinate the end-to-end provider enrollment process for physicians, nurse practitioners, and physician assistants joining the medical group.
Prepare and submit enrollment applications to Medicare, Medicaid, and other applicable payers to establish billing privileges.
Maintain accurate provider data within internal systems (e.g., NPPES, PECOS, CAQH, and iCIMS/HRIS) to ensure consistency across platforms.
Curana Health is dedicated to radically improving the health, happiness, and dignity of older adults. They are a national leader in value-based care, serving 200,000+ seniors in 1,500+ communities across 32 states and employing more than 1,000 clinicians plus other professionals.
Demonstrates proficiency in coding high acuity inpatient accounts and/or coding of technical outpatient accounts.
Supports Revenue Cycle goals for timely billing.
Coding experience of 3-5 years required.
Cooper University Health Care is committed to providing extraordinary health care, with a team of extraordinary professionals dedicated to clinical innovations and enhanced access to facilities, equipment, technologies and research protocols. They offer competitive rates, comprehensive benefits, attractive working conditions, and opportunities for career growth.
Develop collaborative relationships with insurance companies/payors to verify benefits and eligibility.
Enter and update patient demographics, guarantor, and insurance information in company systems.
Respond to inquiries from insurance companies and internal team members.
Equip is a virtual, evidence-based eating disorder treatment program ensuring everyone can access treatment. Founded in 2019, Equip has been fully virtual since its inception and is proud of their highly engaged team, with recognition from Time, Linkedin, and Lattice.
Collaborates with members, family, and healthcare providers to coordinate services and address barriers.
Guides members to achieve optimal health by providing tools and information to understand their healthcare options.
Identifies and assesses members’ medical, behavioral, social, emotional, and financial needs.
Capital Blue Cross promises to go the extra mile for their team and community. They are one of the “Best Places to Work in PA”, with a caring and supportive culture that values professional and personal growth through training and continuing education.
Codes assigned accounts in accordance with the rules, regulations, and coding conventions set forth by NCHS (CDC) and AMA.
Abstract patient data.
Communicates with Care Providers by creating queries to clarify and improve documentation.
Children's Mercy is a pediatric hospital that is committed to making a difference in the lives of all children and shining a light of hope to the patients and families served. They have been recognized by U.S. News & World Report as a top pediatric hospital for eleven consecutive years.
Collecting and verifying current demographic information
Contacting insurance companies when needed
Pediatrix Medical Group is a physician-led organization and one of the nation’s largest providers of prenatal, neonatal, and pediatric services. They focus on a team approach to improve the lives of patients everywhere, offering diverse opportunities and a commitment to clinical excellence.
Conduct research to understand healthcare needs and identify ways to reach caregivers.
Perform telephonic outreach to enroll children in care and ensure onboarding.
Collaborate with healthcare professionals to support patient re-engagement.
Imagine Pediatrics is a tech-enabled, pediatrician-led medical group reimagining care for children with special health care needs. They deliver 24/7 virtual-first and in-home medical, behavioral, and social care, working alongside families, providers, and health plans.
Completes and submits all required documentation in an accurate and timely manner.
Develops and maintains accurate files on each key referral source to provide the location with client information needed to build strong client and branch ties and deliver customer satisfaction.
CommonSpirit Health is a full-service health care organization that believes the best place for our patients to heal is in their own home. As a faith-based organization, they are committed to finding new ways to improve the health of patients and the health of the communities they serve.