Manage pre-service authorization denials and coordinate reconsiderations, appeals, peer-to-peer reviews, and payer exception requests within applicable timeframes.
Interpret payer policies, medical necessity criteria, and coverage requirements to determine appropriate resolution pathways and obtain supporting documentation.
Collaborate with providers, payers, and internal teams to resolve complex cases, identify denial trends, and support process improvement.
Manage prior authorization requests, reviewing clinical documentation and verifying ICD-10 and CPT codes.
Submit requests via payer portals, monitor pending cases, and follow up with insurers.
Investigate denials, prepare appeals, and coordinate with providers to prevent care delays.
Jobgether is an AI-powered job platform that matches candidates with relevant opportunities through objective review processes. It focuses on efficient recruitment and data privacy, using technology to support hiring decisions.
Process referrals and prior authorizations, ensuring accurate and timely documentation.
Collaborate with clinical teams, physician offices, and insurance companies to resolve authorization issues.
Monitor denial reports, manage referral tracking, and communicate decisions to providers, staff, and patients.
Baystate Health is an integrated healthcare system serving western Massachusetts. With 12,000 employees and a community-focused culture, it includes five hospitals and offers career growth.
Prepare, review, and submit accurate prior authorization requests to PBMs and health plans for anti-obesity medications.
Act as an escalation point to resolve complex coverage inquiries from Medical Providers, Member Services, and Client Success.
Maintain HIPAA compliance and accurately document hours using designated ADP pay codes.
Vida is a virtual, personalized obesity care provider that uses evidence-based treatment to help patients manage obesity and related conditions. It is trusted by Fortune 100 companies and fosters a diverse, inclusive culture.
Manage end-to-end case activities for insurance verification, authorization, and reimbursement.
Serve as the single point of contact among patients, providers, payors, and internal teams.
Prioritize competing demands to ensure timely patient access to therapy.
PRO-Spectus supports patient services programs by navigating patient access from benefit verification through claims and reimbursement resolution. The company fosters a supportive, teamwork-driven culture focused on improving patients' lives.
Verify insurance, obtain benefits, calculate estimates, and secure prior authorizations for outpatient services.
Act as liaison between payers and clinic staff; follow up on denied or delayed authorizations.
Maintain detailed documentation and resolve issues with physicians, nurses, and financial advocates.
University of Utah Health is a patient-focused organization enhancing health through care, research, and education. It operates five hospitals and eleven clinics with a culture of collaboration, excellence, leadership, and respect.
Resolve unpaid, denied, or short-paid claims using company billing systems.
Review EOBs and payer correspondence; follow up via portal, phone, email, or fax.
Manage complex denials, appeals, and account resolution with clear documentation.
Hanger, Inc. is the world's premier provider of orthotic and prosthetic (O&P) services and products. With 160 years of clinical excellence, it operates the largest O&P patient care clinic network nationwide, helping people achieve new levels of mobility.
Review and process prior authorization requests for various medications.
Communicate prior authorization criteria to providers and act as a help desk.
Process requests via phone, fax, and web submission while maintaining HIPAA compliance.
Lumicera Health Services is a specialty pharmacy focused on optimizing patient well-being through transparency and stewardship. It fosters a diverse and creative work environment as part of the Navitus organization.
Review appeals of adverse benefit determinations within federal and state regulatory timeframes.
Apply medical policy, coding guidelines, and contractual requirements to assess coverage decisions.
Collaborate with medical divisions and respond to state insurance department inquiries regarding benefit complaints.
Arkansas Blue Cross and Blue Shield is a health insurance provider serving Arkansas. It is consistently ranked as one of the best places to work in Central Arkansas, with an inclusive culture and an average employee tenure of 10 years.
Monitor and manage post payment queues, conducting outreach and negotiation calls to providers.
Communicate with providers to verify understanding of NSA claims payments and regulations.
Maintain HIPAA compliance and document all conversations, payment rates, and counter offers.
Reliant Health Partners is an innovative medical claims repricing service provider that helps employers achieve maximum health plan savings. The company tailors services to each client’s needs and values a diverse, inclusive workplace.
Manage end-to-end drug prior authorization and claims cases, assessing requests against clinical guidelines and plan provisions.
Communicate authorization outcomes clearly to members, providers, and internal stakeholders while resolving escalated and complex scenarios.
Serve as a subject matter expert to support teams, training, and continuous improvement initiatives.
The hiring company operates in the insurance and benefits sector, managing complex drug prior authorization and claims cases. It is a global organization with a collaborative culture that values flexibility, continuous improvement, and employee well-being.
Verify insurance eligibility, coverage, and behavioral health benefits for new and existing patients.
Coordinate prior authorizations, referrals, and coverage resolution with insurance carriers and internal teams.
Manage high-volume requests through EHR systems with strong attention to detail and problem-solving.
Blackbird Health is a clinician-founded provider of virtual and in-person mental health services for children across Pennsylvania, Virginia, New Jersey, and Maryland. The team is collaborative, supportive, and innovative, taking a whole-child approach to care.
Review, investigate, and appeal denied hospital insurance claims using clinical documentation and payer policies.
Develop evidence-based appeal letters addressing medical necessity, level-of-care, and charge discrepancies.
Collaborate with nursing, revenue integrity, and financial teams to resolve denials and prevent future rejections.
This partner company is a healthcare system that provides hospital services and focuses on revenue integrity. It supports fully remote work and values clinical expertise, collaboration, and financial sustainability.
Manage accounts receivable, including analysis of aged AR and identification of root cause issues.
Investigate, resolve, and appeal insurance claim denials, contacting payer representatives as needed.
Collaborate with internal teams and care center staff to drive optimal revenue cycle performance.
Privia Health is a technology-driven physician enablement company that partners with medical groups and health systems to optimize practices and improve patient experiences. It is led by top industry talent and physician leadership with a focus on scalable operations and cloud-based technology.
Obtain managed care authorizations and verify patient insurance benefits prior to services.
Review office schedules daily and update EHR systems with authorization and insurance details.
Coordinate with staff and providers on denials, peer-to-peer reviews, and monthly re-verification of coverage.
Surgery Partners operates a network of surgical facilities and provides healthcare services across the United States. The company fosters a diverse and inclusive workplace, offering comprehensive benefits and professional development opportunities.
Help members navigate US health insurance, including billing questions, denied claims, and appeals.
Coordinate with providers, insurers, and members to resolve coverage issues and prior authorizations.
Translate complex insurance benefits into clear guidance and identify trends to improve the member experience.
This company provides a global safety net for remote workers, offering health, income, and travel coverage. It operates as a remote-first organization with a culture of empathy, integrity, and a mission to improve access to healthcare worldwide.
Review and respond to phone and fax inquiries from members, providers, and pharmacies for prior authorization.
Use multiple applications and follow procedures to accurately document and resolve inquiries.
Provide excellent customer service and meet or exceed call center metrics.
The Cigna Group is dedicated to improving the health and vitality of those we serve through Cigna Healthcare and Evernorth Health Services. We are a major healthcare organization focused on enhancing the lives of our clients, customers, and patients.
Work with insurance companies on behalf of patients to obtain payments for Banner Imaging teams
Research and hold payers accountable to pay expected rates according to contracts within allowed timeframes
Expand knowledge in appeals, follow up on denials, send medical records, verify eligibility and authorization, and negotiate with insurers
Banner Health is one of the largest nonprofit health care systems in the country, providing hospital services and care across multiple states. The organization is nationally recognized, earned Great Place To Work Certification, and offers diverse career opportunities with a strong focus on workplace excellence.
Acts as a central point of contact and provides analytical problem-solving support to Commercial and Medicare Appeals and Grievances staff.
Researches, analyzes, and implements changes to processing procedures to increase department efficiency and meet regulatory compliance.
Supports training, documentation, and compliance activities while serving as a subject matter expert on appeals module configuration.
Capital Blue Cross is an independent licensee of the Blue Cross Blue Shield Association, providing health insurance and wellness programs. The company fosters a flexible, caring culture and is consistently voted one of the "Best Places to Work in PA."