Communicate with patients and explain the Shields Partner Pharmacy program.
Access patient's EMR and review chart notes prior to outbound calls.
Identify medications requiring special storage and necessary supplies.
Shields Health Solutions proactively grows the specialty pharmacy patient population. They provide equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type.
Reviewing patient care notes for clinical data needed for approvals and care plan recommendations.
Monitoring patient adherence across all sites and disease categories.
Recommending alternative therapeutic drug regimens and disease specific treatments according to guidelines.
Shields Health Solutions provides integrated support to patients and physicians. They improve the quality of patient care by personalizing relationships with patients and prescribers to improve medication adherence and promote evidence-based care.
Navigate the Medicare system for patients and caregivers.
Manage care coordination and logistics, including specialist visits.
Advocate for patients by identifying billing errors and cost-saving programs.
Carewell is dedicated to providing a trusted retail source for caregiving products, offering expert-vetted items like incontinence supplies and mobility aids. They are recognized as one of the fastest-growing companies in the US, committed to improving teams, partnerships, and solutions.
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.
Complete monthly utilization management and appeals performance and process audits.
Present audit results to leadership to address issues.
Assist management in identifying, evaluating, and mitigating risks.
Judi Health provides 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 scalable, secure platform.
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.
Lead and oversee Prior Authorization Operations across all lines of business.
Manage Prior Authorization processes ensuring optimal efficiency and compliance.
Drive cross-functional collaboration to align with organizational goals.
Judi Health is an enterprise health technology company providing a comprehensive suite of solutions for employers and health plans. They are rebuilding trust in healthcare in the U.S. and deploying the infrastructure we need for the care we deserve.
Provides integrated off-site support to patients, pharmacists, and providers for total quality patient care.
Delivers medication adherence support utilizing various tools and applications.
Educates prospective pharmacy patients on how the hospital pharmacy improves their overall care.
Shields Health Solutions partners with hospitals to build and manage specialty pharmacies within their systems. They aim to improve medication access, adherence, and outcomes for patients with chronic conditions.
Manage the full enrollment process for Medicare and Medicaid across applicable states.
Prepare, complete, and submit all required enrollment applications and documentation.
Track application status and follow up with agencies to drive timely approvals.
BetterHelp aims to improve mental health and make mental healthcare accessible. They are the world’s largest online therapy service with over 30,000 licensed therapists, and they value employee mental health, investing in their team’s well-being and professional development.
Route clinical questions to providers appropriately.
LumiMeds is a fast-growing telehealth platform focused on weight management and long-term metabolic health. They work with a fully remote, globally distributed team and pride themselves on moving quickly, communicating clearly, and building systems that actually work.