Manage end-to-end case activities throughout the insurance verification and authorization process.
Serve as the single point of contact between the internal/external team, client, provider, payor, facility, and patient.
Provide support across multiple client programs, ensuring effective oversight, operational excellence, and consistent delivery of quality service.
PRO-spectus has created a culture that is supportive, dedicated, and teamwork driven. They celebrate each other’s joys in personal life and professional accomplishments, promoting meaningful relationships and friendships, with humility and compassion at our core.
Contacts insurance companies to determine pre-authorization requirements.
Obtains pre-certification or pre-authorization before service.
Liaisons with physicians to obtain clinical information.
Piedmont Healthcare is a company focused on healthcare services. The job posting does not contain information about the company's size, employees, or culture.
Prepare complex prior authorization requests by identifying clinical guidelines for review.
Proactively obtain clinical information from prescribers to ensure all aspects of clinical guidelines are addressed.
Effectively use problem solving skills to identify gaps and resolve concerns.
Judi Health is an enterprise health technology company providing a comprehensive suite of solutions for employers and health plans. They offer full-service health benefit management solutions, and consolidate all claim administration-related workflows in one secure platform.
Develop collaborative relationships with insurance companies/payors to verify benefits and eligibility.
Enter and update patient demographics, guarantor, and insurance information in company systems.
Respond to inquiries from insurance companies and internal team members.
Equip is a virtual, evidence-based eating disorder treatment program ensuring everyone can access treatment. Founded in 2019, Equip has been fully virtual since its inception and is proud of their highly engaged team, with recognition from Time, Linkedin, and Lattice.
Communicate with insurance companies to facilitate medication approvals.
Navigate pharmacy systems to input data and prepare action plans.
Communicate with patients and clinician offices regarding medication access.
Shields Health Solutions focuses on improving patient care by removing barriers to medication access. They value creating a positive and inclusive work environment where employees can grow their careers.
Own the end-to-end credentialing and payer enrollment process for behavioral health providers across multiple states.
Manage internal credentialing onboarding for newly hired providers by collecting and validating required documentation.
Design and maintain credentialing and enrollment tracking systems to monitor application status, renewal timeliness, and enrollment milestones as the company scales.
Willow Health aims to significantly improve the mental health care experience by expanding affordable access to high-quality, evidence-based intensive behavioral health care. The co-founding team of Cityblock and Oscar alums has two decades of collective experience working in healthcare and healthcare tech, and they are backed by Andreessen Horowitz.
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.
Ensuring accurate and timely documentation in the EHR system.
Collaborating with cross-functional teams to support patient care and billing efficiency.
Phoenix Med Health is an innovative physicians network delivering high quality healthcare to elderly patients in assisted and independent living communities, group homes, and private homes. Phoenix Med Health has 50+ full-time healthcare clinicians and is rapidly expanding the house-call network model with telemedicine.
Guide healthcare providers through the reimbursement process, including prior authorizations and appeals.
Work with insurance companies and third-party administrators to address coverage issues.
Provide education regarding insurance benefits and financial assistance programs.
Amplity is a full-service go-to partner of biopharma companies that delivers flexible + specialized medical + commercial services. Amplity transforms how breakthrough treatments reach the people who need them with expert-led teams delivering contract medical, commercial + communications excellence for 40+ years.
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.
Piedmont Healthcare serves as front line support for the Patient Connection Center. They focus on reviewing orders for outpatient hospital services to ensure completeness prior to scheduling and preparing for the patient visit by verifying patient insurance.
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.
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.
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.
Manage home infusion billing and reimbursement workflows
Handle accounts receivable and payor collections
Resolve complex claims and denials
We connect growth-minded companies with high-impact professionals who drive real results. Whether you're building a team or building a career, our approach is precise, people-first, and built for long-term success.
Review incoming referral orders to assess patient’s needs based on diagnosis, insurance coverage or lack thereof, and previous treatments.
Verify patient information including demographics, insurance coverage and financial status; confirm patient eligibility for health care coverage and clarify any managed care arrangements.
Contact the patient prior to service to inform them of their estimate and collect any pre-payments at that time.
OHSU is Oregon's only public academic health center, caring for patients and leading groundbreaking research. As Portland's largest employer, they offer opportunities to learn and advance in a system of hospitals and clinics across Oregon and Southwest Washington.
Coordinating payor denial and appeal follow up activities to ensure timely response from third party payors.
Communicating and coordinating with various individuals/distributions and assisting with monitoring of the day to day activities related to appeal follow up and denials.
Maintaining the hospital tracking tool/application that stores/communicates all denial and review activity.
Shriners Children’s is an organization that respects, supports, and values each other. They provide excellence in patient care, embracing multi-disciplinary education, and research with global impact and were named the 2025 best mid-sized employer by Forbes.