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.
Perform outbound calls to obtain appropriate information and document accurately.
Answer in-bound calls and assist customers with pharmacy related services.
Contact insurance companies for benefit investigation and coverage eligibility.
IQVIA is a global provider of clinical research services, commercial insights, and healthcare intelligence to the life sciences and healthcare industries. They create connections that accelerate the development and commercialization of innovative medical treatments to improve healthcare and patient outcomes.
Guide healthcare providers through the reimbursement process, including prior authorizations and appeals.
Work with insurance companies and third-party administrators to address coverage issues.
Provide education regarding insurance benefits and financial assistance programs.
Amplity is a full-service go-to partner of biopharma companies that delivers flexible + specialized medical + commercial services. Amplity transforms how breakthrough treatments reach the people who need them with expert-led teams delivering contract medical, commercial + communications excellence for 40+ years.
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.
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.
Provide pre-service support and verify patient insurance benefits.
Contact insurance payers, confirm coverage details, and identify patient responsibilities.
Document all findings to facilitate accurate billing and address potential financial barriers.
CHI Health Clinic offers various healthcare services, including primary and specialty care, walk-in, and virtual services, with over 20 specialties and 100 convenient locations. They focus on providing better access to healthcare so individuals can prioritize their health.
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.
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.
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.
Ensuring accurate and timely documentation in the EHR system.
Collaborating with cross-functional teams to support patient care and billing efficiency.
Phoenix Med Health is an innovative physicians network delivering high quality healthcare to elderly patients in assisted and independent living communities, group homes, and private homes. Phoenix Med Health has 50+ full-time healthcare clinicians and is rapidly expanding the house-call network model with telemedicine.
Contacts insurance companies to determine pre-authorization requirements.
Obtains pre-certification or pre-authorization before service.
Liaisons with physicians to obtain clinical information.
Piedmont Healthcare is a company focused on healthcare services. The job posting does not contain information about the company's size, employees, or culture.
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.
Take inbound calls from patients, providers and members
Support members with their insurance needs, questions or concerns
Provide 24/7 Triage Support and assign priority for a Registered Nurse to provide health advice
Carenet Health pioneers advancements in healthcare consumer experience, interacting with 1 in 3 Americans daily. They integrate human touch with data-driven technology to improve healthcare, offering best-in-class clinical expertise and personalized solutions.
Evaluates certification requests by reviewing the group specific requirements.
Triage the call to determine if a Utilization Review Nurse is needed to complete the call.
Cottingham & Butler sells a promise to help their clients through life’s toughest moments. Their culture is guided by the theme of “better every day” constantly pushing themselves to be better than yesterday.
Contact patient and complete a thorough assessment, including physical, psychosocial, emotional, spiritual, environmental, and financial needs.
Develop treatment plan for standard and catastrophic cases in collaboration with the patient, caregivers or family, community resources and multi-disciplinary healthcare providers that include obtainable short- and long-term goals.
Advocate for the patient by facilitating the delivery of quality patient care, and by assisting in reducing overall costs; provide patient/family with emotional support and guidance.
Personify Health created the first and only personalized health platform—bringing health plan administration, holistic wellbeing solutions, and comprehensive care navigation together in one place. They serve employers, health plans, and health systems with data-driven solutions that reduce costs while actually improving health outcomes and have a mission to empower people to lead healthier lives.
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.
Serve as a key point of contact for patients regarding billing questions, payment plans, and account resolution
Respond to inbound calls and proactively reach out to patients to collect past-due balances and arrange payments
Review and explain Explanation of Benefits (EOBs) to patients in a clear and supportive manner.
IVX Health is a national provider of infusion and injection therapy for individuals managing chronic conditions. They are transforming the way care is delivered with a focus on patient comfort and convenience, empowering their team to thrive while living their core values.
Responsible for the coordination of services for members meeting established criteria, emphasizing education/self-management and promoting quality care and cost-effective outcomes.\n- Uses a collaborative process to assess Member needs, review options for services and resources, develop and implement a plan of care, coordinate resources, monitor progress, and evaluate Member status.\n- Addresses medical, psychosocial, clinical needs, and behavioral health needs including members with mental health and substance use disorder needs, providing counseling and referrals to community/local/state programs.
Capital Blue Cross is committed to providing excellent service to both its team and the community. Employees have consistently voted it as one of the “Best Places to Work in PA”, which indicates a positive and supportive company culture.