Obtains authorizations from Insurance companies for scheduled tests/procedures.
Interprets patient medical records and reviews cases with the insurance nurse reviewer.
Accurately enters information into multiple computer programs and insurance websites.
CoxHealth is a leading healthcare system serving 25 counties across southwest Missouri and northern Arkansas. With six hospitals, 5 ERs, and over 80 clinics, CoxHealth has earned honors for workplace excellence and employs over 14,000 employees.
Coordinating staffing and workload for the financial clearance process.
Verifying eligibility, benefits, referral, and authorization requirements.
Serving as a liaison between patient, referring physician, and insurance plan.
UnityPoint Health is committed to team members and has been 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 support and development opportunities.
Accountable for making decisions supported by policy based on confidential financial information both from the facility and from patients to determine qualification for CICP, Charity programs, or payment arrangements.
Verify coverage and authorization for all scheduled procedures through scheduling and registration information.
Act as a liaison between the patients, physicians, patient clinics, case management, centralized billing office, third party Medicaid eligibility vendor and community agencies.
CommonSpirit is accessible to nearly one out of every four U.S. residents. With our combined resources CommonSpirit is 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.
Responsible for managed care, insurance verification and patient price estimate processes.
Supports ambulatory practices, professional services and hospital departments.
Works closely with internal and external customers to ensure patients receive optimal financial services related to their care.
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.
Review payer PA policy documents for specialty medications and interpret coverage criteria.
Translate policy language into standardized, structured data fields.
Flag ambiguous, conflicting, or unclear policy language.
Quantile Health is a New York-based AI startup focused on expanding patient access to medicines and cutting commercial research costs for the life science industry. They are a fast-growing company using AI agents.
Serves as front line support for the Patient Connection Center.
Reviews orders for outpatient hospital services to ensure completeness prior to scheduling.
Prepares for the patient visit by verifying patient insurance, confirming benefits, determining authorization requirements, reviewing medical necessity, and creating patient liability estimates.
Piedmont Healthcare provides healthcare services. They are a corporate business unit, but employee count isn't specified.
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.
Acts as guidance for PAS Specialists, PAS Trainees and other staff in the areas of health care contract terms, complex patient referrals, and other managed care issues.
Responsible for managed care authorizations for all consultations, procedures, office visits and care arrangements.
Provides and assists with implementation and communication to support staff of new processes within the department, as needed.
Oregon Health & Science University (OHSU) Dermatology is dedicated to providing patients with the best and most innovative dermatologic care for a broad range of skin, hair, nail, and mucous membrane disorders. OHSU values a diverse and culturally competent workforce and is an equal opportunity, affirmative action organization.
Showcase customer service and data entry skills as part of the healthcare team.
Involved in claims adjudication and/or provider credentialing.
Support customers by phone, email and chat.
Sutherland helps customers globally achieve greater agility and transform automated customer experiences. As a digital transformation company they have been in business for over 35 years and are Great Place to Work certified with nearly 40,000 employees.
Prepare and submit credentialing and enrollment packets.
Maintain accurate provider files and track expirations.
Provide assistance to the billing team during staff absences.
Modena Health and Modena Allergy & Asthma are leading medical practices specializing in allergy, asthma, and immunology care, with clinics across Southern California and Arizona and plans for national expansion. They are physician-led and technology-enabled, committed to transforming allergy care while advancing clinical research and expanding access to cutting-edge medicine.
Lead and manage daily prior authorization operations across all locations.
Oversee workload distribution and productivity; Track and mitigate revenue at risk.
Hire, train, coach, and develop authorization supervisors and authorization staff.
Metro Vein Centers specializes in state-of-the-art vein treatments. With over 60 clinics across 7 states, they deliver compassionate, results-driven care in a modern, patient-first environment.
Create a welcoming experience by authentically engaging every caller, every time.
Thoroughly and accurately answer questions about customers’ healthcare accounts.
Thoughtfully listen to callers’ needs and provide appropriate solutions.
Point C is a National third-party administrator (TPA) with local market presence that delivers customized self-funded benefit programs. They research the most effective cost containment strategies and are driving down the cost of plans with innovative solutions.
Support clinical staff by gathering data to complete the medical necessity review process.
Create and send letters to providers and/or members to communicate information.
Collaborate with care management teams and stakeholders to provide optimal service.
Wellmark is a mutual insurance company owned by policy holders across Iowa and South Dakota, and they’ve built their reputation on over 80 years’ worth of trust. They are motivated by the well-being of their members, putting them first and committing to sustainability and innovation.
Own and manage the member-facing phone line, delivering compassionate, timely, and solutions-oriented support.
Manage expedient and accurate Verifications of Benefits (VOBs) to ensure members can access care without delay.
Collaborate and strategize cross-functionally with our member growth team to streamline onboarding and ensure a seamless member experience.
Amae Health provides outpatient psychiatric and primary care health services through value-based care arrangements. They are a Series B venture-backed Public Benefit Corporation dedicated to becoming the nation's center of excellence for individuals living with severe mental illness.
Directly communicate with insurance companies to facilitate the approval of medications.
Navigate pharmacy operating systems to input data and prepare action plans for follow-up.
Communicate directly with patients over the phone to assist them in medication compliance.
Shields Health Solutions provides integrated pharmacy solutions. They partner with hospitals and health systems to improve patient outcomes and create financial value.
Responsible for submitting medical billing claims and appealing denied claims.
Obtain referrals and verify healthcare service eligibility.
Follow up on missed payments and resolve financial discrepancies.
CRMS by DocGo leads the proactive healthcare revolution with an innovative care delivery platform. They disrupt the traditional healthcare system by providing high quality, affordable care with a team of over 5,000 certified health professionals.
Evaluates certification requests by reviewing group specific requirements.
Triage the call to determine if a Utilization Review Nurse is needed.
Cottingham & Butler sells a promise to help clients through life’s toughest moments by hiring, training, and growing the best professionals. The company culture is guided by the theme of “better every day” constantly pushing themselves to be better than yesterday.
Responsible for economic credentialing and provider enrollment with contracted managed care and governmental plans.
Communicating provider participation information to internal and external customers.
Ensures compliance with regulatory agencies and maintains a working knowledge of statues and laws.
The West Virginia University Health System is West Virginia’s largest health system and the state’s largest employer. They have more than 3,400 licensed beds, 4,600 providers, 35,000 employees, and $7 billion in total operating revenues.
Manage fax and mail intake, process medical records requests, and complete insurance pre-authorizations.
Strengthen the operational foundation of our fast-growing digital sleep clinic by handling documentation and correspondence.
Collaborate closely with cross-functional teams in a tech-enabled care environment, contributing to accessible sleep health.
Dreem Health, managed by the Sunrise Group, is America's leading digital sleep clinic that's fixing the broken sleep care patient journey. They connect patients with sleep specialists through a straightforward telehealth platform, eliminating lengthy wait times and complicated in-lab testing.
Collecting and verifying current demographic information
Contacting insurance companies when needed
Pediatrix Medical Group is a leading provider of specialized healthcare for women, babies, and children. Since 1979, they've grown into a national, multispecialty medical group committed to coordinated, compassionate, and clinically excellent services across the continuum of care.