Resolve aged claims and appeals via payer portals & outbound phone calls.
Prioritize assigned work queue to ensure timely work is balanced with working the most payable claims.
Work professionally with Revenue Cycle teammates to be responsive to requests that require your assistance.
CareDx, Inc. is focused on providing healthcare solutions for transplant patients and caregivers. They are the leading provider of genomics-based information for transplant patients.
Assist providers in identifying, reviewing, and validating patient accounts in a credit balance state
Manage accounts receivables to ensure timely collection of identified Client overpayments
Prioritize workload to meet deadlines and goals using guidelines set out by manager
TREND Health Partners is a tech-enabled payment integrity company, dedicated to facilitating collaboration between payers and providers for mutual benefit and waste reduction, ultimately improving access to healthcare. It is a dynamic growing organization that promotes a collaborative and innovative work environment.
Contacts insurance companies for status on outstanding claims.
Processes and follows up on appeals to insurance companies.
Works outstanding accounts receivable from assigned work queues.
US Anesthesia Partners is a company focused on revenue cycle management. They provide equal employment opportunities to all employees and applicants and value diversity based factors.
Ensure coordination of provider invoice activities to support timely reimbursement.
Research and resolve claim denials that fail payer edits, preparing corrections and appeals.
Verify patient eligibility, benefits, and health‑plan information using payer databases.
CareCentrix supports value-based care by providing care management and transition of care services. They focus on improving patient outcomes and managing healthcare costs through a range of programs and services. The company values caring, doing the right things and striving for excellence.
Facilitating the analysis and research of EOB’s to problem solve outstanding accounts.
Analyze credit balances and issues refunds as necessary.
CommonSpirit Health is a healthcare organization with over 700 care sites across the U.S., offering services from clinics and hospitals to home-based and virtual care. They are committed to building healthy communities and advocating for those who are poor and vulnerable.
Resolve aging AR through root cause analysis and follow up remediation actions.
Handle client and provider billing inquiry escalations
Investigate, appeal and resolve denied or underpaid claims
SonderMind is a mental health service provider aiming to provide personalized and effective mental healthcare. They combine technology and human connection to drive better outcomes through a comprehensive approach, offering therapy, medication management, meditation, and mindfulness exercises.
Responsible for daily billing functions and claim edits.
Reviews insurance claims for accuracy and identifies non-payment issues.
Contacts parties for claim information and works first-level appeals.
Kettering Health is a not-for-profit system of 14 medical centers and more than 120 outpatient facilities serving southwest Ohio. Their mission is to live God’s love by promoting and restoring health.
Responsible for complete, accurate, and timely processing of all designated claims.
Investigates denial sources, resolves and appeals denials, which may include contacting payer representatives.
Works with internal teams and care center staff to ensure optimal revenue cycle functionality.
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. Their platform consists of scalable operations and cloud-based technology that reduces unnecessary healthcare costs, achieves better outcomes, and improves the health of patients and the well-being of providers.
Review medically complex claims, pre-authorization requests, appeals, and fraud/abuse referrals.
Assess payment determinations using clinical information and established guidelines.
Evaluate medical necessity, appropriateness, and reasonableness for coverage and reimbursement.
Broadway Ventures transforms challenges into opportunities with expert program management, cutting-edge technology, and innovative consulting solutions. As an 8(a), HUBZone, and Service-Disabled Veteran-Owned Small Business (SDVOSB), they empower government and private sector clients by delivering tailored solutions that drive operational success, sustainability, and growth.
Responsible for insurance follow-up and collections, including phone calls and accessing payer websites.
Identify root cause issues for denials and coordinate with clinic and management for process improvements.
Resolve complex inventory, including payment research, and accurately document collection activity.
Anne Arundel Dermatology provides comprehensive medical, surgical, and esthetic skin care services. With over 250 clinicians and 110 locations across 7 states, they are experiencing growth and looking for talented individuals to join their team.
Resolve claims rejections and denials in work queues as assigned.
Resolve outstanding claims based on an accounts receivable report.
Submit appeals to payors for non-payment of claims as needed.
Ennoble Care is a mobile primary care, palliative care, and hospice service provider with patients in multiple states. They offer a variety of programs designed to ensure patients receive the highest quality of care by a team they know and trust.
Serve as a subject matter expert for front-end revenue cycle functions.
Investigate and resolve complex billing issues that prevent claims from being successfully accepted by payers.
Conduct root cause analysis on recurring front-end issues and implement process improvements to reduce claim errors and rework
Natera is a global leader in cell-free DNA (cfDNA) testing, dedicated to oncology, women’s health, and organ health. The Natera team consists of highly dedicated statisticians, geneticists, doctors, laboratory scientists, business professionals, software engineers and many other professionals from world-class institutions.
Submit bills compliant with all appropriate regulations and managed care contracts.
Collect money due by contacting third parties and providing explanations of charges.
Analyze accounts to determine coordination of benefits, refunds, and denials.
They are Oregon's only public academic health center, involved in patient care, research, and training healthcare professionals. As Portland's largest employer, they offer opportunities for learning and advancement in hospitals and clinics across Oregon and Southwest Washington.
Analyze and evaluate worker’s compensation claim payments using EnableComp’s proprietary software, systems and tools.
Research, request and acquire all pertinent medical records, implant manufacturer’s invoices and any other supporting documentation necessary and then submit with hospital claims to insurance companies to ensure prompt correct claims reimbursement.
Conduct timely and thorough telephone follow-up with payers to ensure claims with supporting documentation have been received and facilitate prompt reimbursement.
EnableComp provides Specialty Revenue Cycle Management solutions for healthcare organizations, leveraging over 24 years of industry-leading expertise and its unified E360 RCM ™ intelligent automation platform to improve financial sustainability. EnableComp is a multi-year recipient the Top Workplaces award and was recognized as Black Book's #1 Specialty Revenue Cycle Management Solution provider in 2024.
Responding to high volume inquiries via email/phone
Assist with triaging case volumes
Providing resolution guidance/support to care center staff on complex claims/billing inquiries; claim holds, overrides, take backs, corrected claim workflows, coding assistance
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 consists of scalable operations and end-to-end, cloud-based technology that reduces unnecessary healthcare costs, achieves better outcomes, and improves the health of patients and the well-being of providers.
Acts as a resource for collection issues and ensures patient accounts are accurate.
Monitors patient A/R, sends statements, and posts payments according to standards.
Documents all activity on accounts and prepares data needed for court-related circumstances.
Munson Healthcare is northern Michigan’s largest healthcare system, with eight award-winning community hospitals serving over half a million residents across 29 counties. They are a team that delivers outstanding care in one of the most beautiful regions in the country.
Supports the affiliate-level Utilization Management and denials processes by coordinating incoming requests for information from multiple payer sources.
Conducts maintenance and utilization of EPIC work queues that support obtaining authorization for patient stays; communicates with payers via telephone, fax, or email.
Acquires an understanding of third party authorizations, verification, and denials, and proceeds with notification/documentation to appropriate parties.
UnityPoint Health is committed to its team members and recognized as a Top 150 Place to Work in Healthcare by Becker's Healthcare several years in a row. They champion a culture of belonging where everyone feels valued and respected, honoring the ways people are unique and embracing what brings us together.
Assess referred concurrent denials and determine next steps for resolution.
Review medical record documentation to support denial management strategies.
Advocate for patients to ensure coverage and reimbursement.
They are currently looking for a Utilization Management Coordinator. By enhancing operational efficiencies and implementing educational initiatives, this role significantly impacts the financial and quality outcomes of healthcare delivery.