The Insurance Reimbursement Specialist maximizes reimbursement by collecting outstanding balances from insurance companies. The Specialist follows up on unresolved claims and escalates claims for reconsiderations. The Specialist works with CareDx Payer Dispute Resolution/Market Access teams ensuring proper reimbursement from payers.
CareDx, Inc. is focused on the discovery, development, and commercialization of clinically differentiated, high-value healthcare solutions for transplant patients.
Responsible for collections and appeals from various Federal, State, & Third Party (HMO, PPO, IPA, TPA Indemnity) payers.
Optimize payment reimbursements by reviewing accounts for billing accuracy and health plan coverage.
Process an appeal, resubmit/rebill, or forward claims for adjudication as necessary.
BillionToOne is a next-generation molecular diagnostics company on a mission to make powerful, accurate diagnostic tests accessible to everyone. Forbes recently named them one of America's Best Startup Employers for 2025, and they were awarded Great Place to Work certification in 2024.
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.
Capital Blue Cross promises to go the extra mile for their team and community. Employees consistently vote it one of the “Best Places to Work in PA”.
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.
Host demos for our partners, including for end users and management teams, to showcase our functionality and get them excited about being a partner.
Run contracting processes with management teams to get their Parachute journey started.
Place outbound phone calls to prospective Home Medical Equipment (DME) supplier partners to educate them on the Parachute Platform.
Parachute Health is transforming post-acute care through the leading digital ordering platform for medical equipment and supplies. Their platform connects a vast network of Home Medical Equipment providers, clinicians, and payors across all 50 states. We replace the outdated, error-prone paper and fax process, with a system that’s 10 times faster.
Proactively provides education on access and reimbursement topics.
Manages the pull-through of access and reimbursement strategy within aligned accounts.
Communicates requirements and addresses barriers associated with payer policy coverage.
Improving the lives of people living with disease takes more than innovative science; It takes a focus on the needs of people and a community committed to meeting them.
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.
Provide excellent customer service and product information to patients and providers.
Support field teams, operations, and sales by delivering timely feedback.
Proactively create a better patient experience.
Apria Healthcare's mission is to improve the quality of life for patients at home by providing home respiratory services and select medical equipment. They strive to meet the needs of their patients with empathetic, thoughtful, and compassionate people.
Plan, direct, and coordinate activities to support product use within designated accounts.
Coordinate training activities for all accounts in the territory.
Collaborate with Clinical Account Managers (CAMs) within each territory.
Jobgether uses an AI-powered matching process to ensure your application is reviewed quickly, objectively, and fairly against the role's core requirements. Our system identifies the top-fitting candidates, and this shortlist is then shared directly with the hiring company.
Provide empathetic and solution-focused assistance through various channels.
Drive member engagement from enrollment through program completion.
Establish human connections with members and provide personalized support.
Sword Health is shifting healthcare from human-first to AI-first through its AI Care platform, making world-class healthcare available anytime, anywhere.
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.
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.
Play a crucial part in building trust and establishing strong relationships with healthcare professionals.
Drive revenue growth by identifying new business opportunities while managing existing accounts.
Collaborate with cross-functional teams to enhance the customer experience and deliver tailored solutions.
Jobgether uses an AI-powered matching process to ensure your application is reviewed quickly, objectively, and fairly against the role's core requirements. Their system identifies the top-fitting candidates, and this shortlist is then shared directly with the hiring company.
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.
Deliver comprehensive care navigation and access support for Sana members, ensuring they receive the right care at the right time, place, and cost.
Collaborate with cross-functional teams, including our virtual care practice and customer support, to provide seamless care navigation services.
Educate members on their care referral options, empowering them to make informed healthcare decisions.
Sana Benefits is building affordable health plans designed around Sana Care, their integrated care model connecting members with unlimited primary care and expert care navigation at no additional cost to them. They've compiled an innovative team with top talent from across the healthcare and technology industries to deliver engaging, modern, concierge-style healthcare for their members.
Perform detailed analysis of remittances, explanations of benefits (EOBs),payer correspondence, and account detail to identify underpayments or incorrect claim adjudications.
Prepare and submit detailed appeals with appropriate documentation and contract references to secure accurate reimbursement.
Identify and document systemic payer issues and trends affecting reimbursement.
TREND Health Partners is a tech-enabled payment integrity company. They facilitate collaboration between payers and providers for mutual benefit and waste reduction, ultimately improving access to healthcare. Joining TREND Health Partners means becoming part of a dynamic, growing organization that promotes a collaborative and innovative work environment.
Answer incoming inquiries from patients, answer questions, and schedule appointments
Make outbound phone calls to patients, pharmacies, and insurance companies
Create and triage tickets in ServiceNow
Talkiatry transforms psychiatry with accessible, human, and responsible care. They’re a national mental health practice co-founded by a patient and a triple-board-certified psychiatrist to solve the problems both groups face in accessing and providing the highest quality treatment.