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.
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.
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 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.
Coordinates utilization review and prior authorization requests, ensuring accurate entry into the UM platform.
Provides customer service to providers and members, confirming benefits and answering authorization questions.
Facilitates communication between reviewers, hospitals, and physicians to ensure timely decisions.
University of Utah Health Plans is a patient-focused organization that enhances health through patient care, research, and education. It is part of a nationally ranked academic medical center with five hospitals and eleven clinics, fostering a culture of collaboration and excellence.
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.
Handle inbound calls, chats, emails, and faxes from healthcare providers, resolving questions on authorizations, claims, and provider services.
Document each interaction, research issues, and ensure accurate, timely follow-up with providers.
Guide providers through processes like checking authorization status, submitting claims, and navigating the provider portal.
Curana Health is a national leader in value-based care, offering senior living and skilled nursing facilities solutions such as on-site primary care, ACOs, and Medicare Advantage plans. Founded in 2021, it serves 200,000+ seniors in 1,500+ communities across 32 states with 1,000+ clinicians.
Manage patient intake processes by scheduling, rescheduling, and canceling appointments.
Verify and update patient demographics, insurance eligibility, and collect payments.
Process referrals and authorizations while responding to patient inquiries with professional communication.
A comprehensive healthcare network serving the Puget Sound region with a full spectrum of health care services, from routine wellness to complex disease management. It includes 10 hospitals and nearly 300 care sites, fostering a culture of compassionate care and shared purpose.
Serve as the first point of contact, greeting patients and handling inbound calls.
Verify insurance, update demographics, and register patients in EMR (EPIC).
Document patient concerns, triage messages, and escalate emergent issues promptly.
U.S. Urology Partners provides urology and specialty services, including surgery and cancer treatment. It has over 50 offices across the East Coast and Midwest, with values of compassion, collaboration, respect, and accountability.
Leads enterprise authorization operations with direct impact on revenue protection, patient access, and reimbursement performance.
Manages a team responsible for insurance verification, pre-authorization, and timely processing of assigned services.
Collaborates with billing, registration, revenue cycle, clinical, and administrative teams to reduce preventable payment denials.
The partner company is a healthcare organization focused on revenue protection, patient access, and reimbursement performance. They provide a collaborative and mission-driven environment for teams working across complex healthcare operations.
Address patient and DPOA inquiries via phone and patient portal, and assist with scheduling follow-up appointments.
Manage electronic health records, maintain patient rosters, and facilitate provider orders and prior authorizations.
Collaborate with the Curana interdisciplinary care team and handle incoming calls professionally.
Curana Health is a national leader in value-based care for senior living, offering on-site primary care and Medicare Advantage plans. Founded in 2021, it has grown to serve 200,000+ seniors in 1,500+ communities, with a team of 1,000+ clinicians and staff, ranking #147 on the Inc. 5000.
Verify insurance eligibility and coverage for patients using online systems and phone calls.
Input and update insurance information, identify primary and secondary coverage, and manage COB order.
Obtain pre-authorizations and communicate necessary information to Utilization Management.
Munson Healthcare is northern Michigan's largest healthcare system, with eight community hospitals serving over half a million residents across 29 counties. The culture emphasizes excellence, teamness, positivity, creativity, and a commitment to creating exceptional experiences for patients and each other.
Receive medical claims from healthcare providers or patients and verify supporting documentation to ensure completeness.
Interpret Explanation of Benefits (EOB) and CMS-1500 forms, then evaluate claims against program-specific business rules for approval or rejection.
Provide support to customer inquiries via phone, email, or fax while maintaining HIPAA compliance and meeting daily productivity goals.
IQVIA is a leading global provider of clinical research services, commercial insights, and healthcare intelligence to the life sciences and healthcare industries. With operations in over 100 countries, they cultivate a diverse, collaborative culture focused on improving patient outcomes.
Serve as the first point of contact for patients, scheduling appointments and coordinating referrals.
Verify insurance and demographic information, ensuring accuracy and compliance.
Document interactions in electronic medical records and escalate complex issues appropriately.
This role is posted on behalf of a partner company, and managed through Jobgether's AI-powered matching process. The company is a healthcare support provider that values compassion and efficiency in patient access services.
Process incoming medical referrals, enter accurate data into medical management systems, and assign appropriate healthcare providers.
Review referrals for benefits and medical necessity, escalate sensitive cases for clinical assessment, and apply ICD-10 and CPT codes.
Communicate with military treatment facilities and civilian providers, respond to inquiries, and manage referral tasks within established timelines.
This position is listed on behalf of a partner company that manages all applications and next steps. The company supports healthcare service delivery by ensuring medical referrals are processed accurately and efficiently within a structured, collaborative remote team.
Conduct outbound calls to members to schedule Annual Wellness Visits, preventive screenings, and primary care consultations.
Educate members about available healthcare benefits and the importance of completing recommended visits.
Coordinate with provider offices and internal teams to secure appointment availability and maintain accurate documentation.
This company provides population health and care coordination programs, helping members access preventive and primary care services. The team operates as a remote, performance-driven call-center environment focused on member outreach and appointment scheduling.
Review and verify healthcare claims for accuracy, coding, eligibility, and coverage.
Approve or deny claims according to policy terms and regulations, and resolve discrepancies.
Process claims efficiently, meet performance targets, and maintain accurate records.
Blue Cross and Blue Shield of Kansas is a health insurance company providing coverage to Kansans. With over 80 years in the community, it fosters an inclusive, family-first culture and supports professional growth.
Greet patients professionally in person and over the telephone, setting a positive tone for their visit.
Obtain and verify all required patient and insurance information, entering it accurately into the registration system.
Schedule patient appointments, including return visits, referrals, and diagnostic procedures.
Munson Healthcare is northern Michigan's largest healthcare system, operating eight award-winning community hospitals serving over half a million residents across 29 counties. They emphasize a culture of excellence, teamwork, positivity, and creativity, with a focus on exceptional patient experiences.
Take inbound calls from patients, providers, and members, handling everything from routine questions to emergent situations.
Support members with insurance needs, including changing primary care physicians, locating urgent care clinics, and getting prescription authorizations.
Provide 24/7 Triage Support and assign priority for a Registered Nurse to deliver health advice.
Carenet Health pioneers advancements across the healthcare consumer journey, interacting with 1 in 3 Americans daily to deliver positive healthcare experiences and improve outcomes. For over 30 years, the company has combined clinical expertise with data-driven technology, fostering a collaborative and innovative culture that empowers growth through trust, opportunity, and accountability.