Source Job

• 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.

• Maintain full ownership and accountability for initiating phone contact to potential study participants.
• Conduct phone-based pre-screening interviews for potential study participants to determine pre-qualification status.
• Consistently provide outstanding customer service with every patient interaction.

M3 Wake Research is an integrated network of premier investigational sites meeting clinical research needs. They have close to 30 owned and managed research sites across the country and continue to grow through acquisitions.

• Conduct high-volume outbound and inbound calls with patients, providers, and pharmacies.
• Collaborate with patients to identify and remove barriers to medication adherence.
• Accurately document all interactions, outcomes, and identified barriers in appropriate systems.

Aledade empowers independent primary care practices. They were founded in 2014 and have become the largest network of independent primary care in the country, with a collaborative, inclusive, and remote-first culture.

• Enrolling practitioners in health plans in a timely and effective fashion.
• Monitoring progress and ensuring timeliness of enrollment completion.
• Maintaining provider enrollment goals for all divisions.

Pediatrix Medical Group provides specialized health care for women, babies, and children. Since 1979, Pediatrix has grown into a national, multispecialty medical group committed to coordinated, compassionate, and clinically excellent services.

• Act as the primary point of contact for incoming member calls and prior authorization inquiries.
• Accurately advise callers on options for exception requests based on client benefit elections.
• Efficiently triage incoming calls with professional phone etiquette from members, prescribers, and pharmacies.

Judi Health is an enterprise health technology company providing a comprehensive suite of solutions for employers and health plans. They manage health benefits for employers, TPAs, and health plans and are rebuilding trust in healthcare in the U.S.

• Team members will perform outbound calls to enroll the person into their food box program or to reauthorize the person into the program.
• Have a passion for helping members make decisions that will enhance their healthcare experience
• You will be making a difference in someone’s life!

Carenet Health has pioneered advancements for an experience that touches all points across the healthcare consumer journey. From best-in-class clinical expertise to personalized and automated solutions, they integrate the power of human touch with data-driven technology in their mission to make healthcare better for all.

• Initiate communication to communities regarding expensive and non-formulary medication orders.
• Keep detailed records of all orders that require communication to the community.
• Review Medicare D rejections and prior authorizations, and coordinate with pharmacists or physicians.

Symbria Rx Services delivers patient-centered care to the geriatric population in senior-living and post-acute settings. As one of the few 100% employee-owned companies in healthcare, our business practices are guided strictly by the values to which our employee owners are committed to.

• Handle inbound and outbound calls to support our healthcare client.
• Expected to deliver exceptional customer service by adhering to established protocols and guidelines.
• Utilize various web-based systems to efficiently address and resolve customer inquiries.

Senture is a global company that embraces diversity and never discriminates against employees or applicants based on gender identity or expression, sexual orientation, race, religion, age, national origin, citizenship, disability, pregnancy status, veteran status, or other differences. They have employees from various backgrounds and lifestyles.

• Conduct routine patient check‑ins to monitor therapy experience, identify concerns, and support adherence to treatment plans.
• Assist with initial outreach to confirm therapy start and assess early treatment experience.
• Coordinate patient appointments, follow‑up visits, and clinical monitoring schedules.

Shields Health Solutions partners with hospitals and health systems to develop and manage specialty pharmacies. They focus on improving patient outcomes, enhancing financial performance, and ensuring regulatory compliance for their partners.

• Collaborate with clinic teams to deliver hands-on patient care.
• Process prior authorizations, resolve insurance issues, and support financial assistance.
• Educate patients on pharmacy services and assist with specialty and retail prescriptions.

Shields Health Solutions is redefining patient care through specialty pharmacy. They are hiring motivated people and seem to have a good employee culture.

• Consistently practices Patients First philosophy and adheres to high standards of customer service.
• Correctly identifies and collects patient demographic information in accordance with organization standards.
• Uses effective service recovery skills to solve problems or service breakdowns when they occur.

At Northwestern Medicine, every patient interaction makes a difference in cultivating a positive workplace, setting it apart as a leader in the healthcare industry. As an integral part of the team, you'll have the opportunity to join our quest for better health care, with competitive benefits from tuition reimbursement and loan forgiveness to 401(k) matching.

• Reaching out to health plan members.
• Guiding them toward scheduling their care assessments.
• Giving them the encouragement they need to take that next step.

Carenet Health turns everyday conversations into meaningful connections that help people take charge of their health. They value the expertise and dedication of their team members and show it through a competitive and supportive package.

• Coordinate case management activities related to medication optimization, adherence, and therapeutic appropriateness
• Collaborate with providers, PBMs, and pharmacy partners to support evidence-based medication use and access
• Conduct member outreach, education, and follow-up to support adherence and understanding

Point C is a national third-party administrator (TPA) delivering customized self-funded benefit programs with local market presence. They focus on cost containment strategies with innovative solutions. They are driven by a clear and impactful mission.

• Track and manage prior authorization requests, renewals, and extensions.
• Verify member eligibility and benefits to confirm coverage requirements.
• Upload, organize, and maintain member records and clinical documentation accurately and timely.

Leap is a benefits solution company focused on reshaping how life-changing therapies are delivered and financed. They are a fast-growing company that partners with Fortune 500 companies and leading TPAs, focusing on lower costs, improved access, and better care.

• Answers first level calls in Utilization Review.
• 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.

• Serve as the client liaison for all incoming intake calls to the organization in a welcoming, energetic manner.
• Demonstrate knowledge of organizational structure and criteria to clients, providing educated answers to clinical questions.
• Initiate client Biopsychosocial Assessment by utilizing motivational interviewing techniques and schedule initial intake appointment utilizing EMR.

Groups Recover Together was founded in 2014 to make treatment for opioid addiction respectful, accessible, and affordable. They empower their members to regain control of their lives through a combination of community support, outpatient weekly group therapy and medication.

• Build trusting relationships with patients, families, and providers, addressing health questions and care needs.
• Identify medical, behavioral, social, emotional, and financial needs to support whole‑person care.
• Strengthen the connection between patients and healthcare providers by addressing barriers and facilitating communication.

Guidehealth is a data-powered, performance-driven healthcare company dedicated to operational excellence, with the goal to make great healthcare affordable, improve patient health, and restore fulfillment for providers. They leverage remotely-embedded Healthguides™ and a centralized Managed Service Organization to build stronger connections with patients and providers.

• Serve as the primary contact for patients throughout the therapy process.
• Monitor all patient cases for delays or obstacles and coordinate with healthcare providers.
• Maintain accurate documentation and reporting of access barriers, interventions, and outcomes.

Jobgether is a platform advertising this job on behalf of a partner company. They are looking for candidates to fill the role.

• 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.