Researches and analyzes data to answer questions and find trends.
Reviews carrier websites, regulations, and policies related to coding and reimbursement.
Prepares and presents quality reports, reviews, and analysis.
OSU Physicians provides exceptional patient care while fostering a collaborative work environment. They include more than 1,800 nurses, medical assistants, physicians, advanced practice providers, administrative support staff, IT specialists, financial specialists and leaders.
Responsible for complete, accurate and timely processing of all designated claims.
Investigating denial sources, resolving and appealing denials which may include contacting payer representatives.
Drive toward achievement of department’s daily and monthly Key Performance Indicators (KPIs), requiring a team focused approach to attainment of these goals.
Privia Health is a technology-driven, national physician enablement company that collaborates with medical groups, health plans, and health systems to optimize physician practices, improve patient experiences, and reward doctors for delivering high-value care in both in-person and virtual settings. The Privia Platform is led by top industry talent and exceptional physician leadership.
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 and maintain a clear audit trail for future reference.
Record after-call actions and perform post-call analysis for the claim follow-up.
TruBridge connects providers, patients, and communities with innovative solutions that create real value by supporting both the financial and clinical sides of healthcare delivery. They are a remote team that encourages their employees to push boundaries and look at things differently.
Serve as the authoritative SME on technical CARC/RARC codes, mapping, and workflows.
Define product requirements for auto-scrub, intelligent resubmission, documentation-request automation, and worklist prioritization for soft denials.
Design root-cause prevention logic that feeds denial patterns upstream to SmarterPrebill, SmarterUM, and Patient Access.
Smarter Technologies is a healthcare technology company focused on transforming how healthcare services are delivered, managed, and reimbursed. They bring together Access Healthcare, SmarterDx, Thoughtful AI, and Pieces, combining deep healthcare services expertise with advanced data, automation, and AI capabilities.
Serve as the vendor’s lead clinical subject matter expert on clinical denials management and prevention.
Partner with provider clients to design and implement best practices for denial prevention and appeal workflows.
Conduct complex clinical case reviews for DRG validation, identifying and defending clinically appropriate DRG assignments.
EnableComp provides Specialty Revenue Cycle Management solutions for healthcare organizations. They leverage over 24 years of expertise and their E360 RCM ™ platform to improve financial sustainability for hospitals, health systems, and ambulatory surgery centers. EnableComp is a multi-year recipient of the Top Workplaces award recognized as Black Book's #1 Specialty Revenue Cycle Management Solution provider in 2024.
Serve as senior escalation point for client performance.
Lead Quarterly Business Reviews (QBRs).
Ternium RCM specializes in resolving complex healthcare insurance claim denials and delays. They empower hospitals and health systems by optimizing their revenue cycle, allowing them to focus on patient care. The company delivers outstanding results and enhances the patient experience.
Auditing to ensure new provider and care center information is accurate.
Conducting Care Center audits based on the number of providers.
Identifying, monitoring, and managing denial management trends.
Privia Health is a technology-driven, national physician enablement company. They collaborate with medical groups, health plans, and health systems to optimize physician practices and improve patient experiences. Their platform is led by industry talent and cloud-based technology.
Serve as the single accountable owner for full client setup and ongoing RCM performance across all sites.
Actively monitor AR aging, denials, authorization timeliness, claim submission lag, payer trends, utilization, and workflow metrics.
Own performance reporting and visibility across accounts and build and maintain dashboards.
Prompt Therapy Solutions is building software for rehab therapists, helping outpatient rehab organizations treat more patients and deliver better care with less environmental waste. They are a talented team of individuals who have built software to turn a paper-heavy industry digital.
Partner with Clinical, Claims, and Payment Integrity peers to review claims for DRG related issues.
Proactively identify overpayments to ensure accurate claims payments on inpatient services.
Participate in collaborative discussions with MDs to verify the clinical rationale behind billed procedures.
They are reinventing health insurance by combining data with human empathy to keep members healthier. Clover Health believes the healthcare system is broken, so they've created custom software and analytics to empower their clinical staff to intervene and provide personalized care to the people who need it most. They are passionate and mission-driven individuals with diverse areas of expertise, working together to solve the most complicated problem in the world: healthcare.
The Hospital Contract Definition Analyst plays a critical role in the implementation and maintenance of hospital payer contracts within Experian Health's Contract Manager system.
You will ensure accurate modeling of reimbursement methodologies to support valuation of hospital claims and patient estimates and collaborate with senior team members to process new client implementations.
Independently manages routine maintenance cases, ensuring compliance with enterprise standards and client expectations.
Experian is a global data and technology company, powering opportunities for people and businesses around the world. A FTSE 100 Index company listed on the London Stock Exchange (EXPN), they have a team of 23,300 people across 32 countries where their corporate headquarters are in Dublin, Ireland.
Spring Health aims to revolutionize mental healthcare by removing barriers to access. They partner with over 450 companies and offer mental health services to 10 million people, with a valuation of $3.3 billion after their Series E Funding.
Prepare documentation, review claim history, and investigate requests.
Utilize available resources to investigate claim situations for cases.
Follow-up with responsible departments and delegated entities to ensure compliance.
Centivo is an innovative health plan for self-funded employers, aiming to provide affordable, high-quality healthcare. They work with employers ranging in size from 51 employees to Fortune 500 companies and are headquartered in Buffalo, NY with offices in New York City and Buffalo.
Analyzes new and revised hospital contracts, determines necessary actions, documents requirements, and establishes customer accounts.
Effectively communicates with external and internal customers throughout the contract process to ensure timely information reception.
Identifies opportunities and initiates process improvements, including written documentation in a process manual.
Pediatrix Medical Group is a physician-led organization and one of the nation’s largest providers of prenatal, neonatal, and pediatric services. They are an exciting and innovative company that focuses on a team approach to improve the lives of patients everywhere.
Evaluate, procure and incorporate data sources to support and monitor the performance of lorundrostat in hypertension.
Oversee the design and implementation of dashboards, KPIs, and reporting tools to monitor brand performance and commercial effectiveness for cross-functional stakeholders.
Manage external vendors to ensure timely and high-quality delivery of analytics projects.
Mineralys Therapeutics is a clinical-stage biopharmaceutical company focused on developing medicines to target hypertension and related comorbidities. Mineralys is a fully remote company.
Confirm insurance premium payments are sent in a timely manner to avoid lapses in OHSU coverage.
Maintain meticulous records of all department and captive insurance program financial transactions, performs bank reconciliations, and assists outside auditors with scheduled audits.
Prepare accurate and timely financial reports for VP/Chief Risk Officer, captive manager, OHSU departments and auditors.
Oregon Health & Science University's Risk Management department provides a comprehensive risk management program that contributes to health, safety and protection of patients, employees, faculty, students and visitors, while also protecting the OHSU's physical and financial resources. OHSU values a diverse and culturally competent workforce.
Investigate and determine whether medical insurance claims are recoverable from a liable third party.
Communicate and negotiate with healthcare plan members, insurance adjusters, and attorneys.
Utilize computer systems to accurately document collected information.
Machinify is a leading healthcare intelligence company that delivers value, transparency, and efficiency to health plan clients. With over 85 health plans and 270 million lives represented, we bring together a configurable, AI-powered platform along with expertise.
Review payer financial reconciliations for accuracy and adherence to agreed-upon methodologies.
Support for the development and deployment of audit procedures applied to payer data sets.
Partner across teams and with payers to resolve data discrepancies.
Aledade empowers independent primary care practices to deliver better care to their patients and thrive in value-based care. They are the largest network of independent primary care in the country with a collaborative, inclusive, and remote-first culture.
Attend and participate in forecast meetings and pipeline reviews.
Analyze customer licensing, products, and usage for revenue opportunities.
Develop dashboard requirements to provide visibility to pipeline and transactions.
ServiceNow, founded in 2004, provides AI-enhanced technology to over 8,100 customers, including 85% of the Fortune 500. Their intelligent cloud-based platform connects people, systems, and processes to empower organizations to find smarter, faster, and better ways to work.
Own the day-to-day tracking and progress of clinician credentialing and payer enrollment workflows.
Identify and resolve blockers across credentialing, enrollment, and re-credentialing processes.
Support clinicians directly by guiding them through credentialing and enrollment requirements.
Wheel is evolving the traditional care ecosystem by equipping companies with a premier platform to deliver virtual care at scale. They offer strategies and technologies to foster consumer engagement, build brand loyalty, and maximize return on investment.
Educate HCPs on Patient Support Programs, providing tailored education to healthcare providers and their staff.
Provide Reimbursement Expertise, educating HCPs on the local payer landscape through education engagements.
Address Access Barriers, providing assistance to HCPs to compliantly troubleshoot claims at retail pharmacies.
Valeris is a fully integrated life sciences commercialization partner providing comprehensive solutions across the healthcare value chain. Formed by the merger of PharmaCord and Mercalis, they work on behalf of life sciences companies to improve the patient experience. They provide commercialization solutions to more than 500 life sciences customers and have provided access and affordability support to millions of patients.