Contacts insurance companies to determine pre-certification requirements. Obtains pre-certification prior to the scheduled complex service being performed. Liaisons with physicians to obtain additional information.
Piedmont Healthcare contacts insurance companies and other third party payers to determine pre-certification, pre-authorization and/or medical necessity requirements.
Manages referrals both into and out of the clinic, including prior authorizations and medical records.
Efficiently calls patients, schedules appointments, verifies insurance, and confirms demographics.
Requires excellent customer relationship skills and the proven ability to communicate effectively and accurately.
Munson Healthcare is northern Michigan’s largest healthcare system, with eight award-winning community hospitals serving over half a million residents.
Process transactions on insurance accounts and interact with insurance companies.
Communicate with staff and third-party customers to ensure accurate processing.
Prioritize accounts to maximize aged AR resolution, and research documentation.
Oregon Health & Science University values a diverse and culturally competent workforce. They are proud of their commitment to being an equal opportunity, affirmative action organization that does not discriminate against applicants on the basis of any protected class status, including disability status and protected veteran status.
Coordinating staffing and workload for the financial clearance process.
Verifying eligibility, benefits, referral, and authorization requirements.
Serving as a liaison between patient, referring physician, and insurance plan.
UnityPoint Health is committed to team members and has been recognized as a Top 150 Place to Work in Healthcare by Becker's Healthcare. They champion a culture of belonging where everyone feels valued and respected, and provide support and development opportunities.
Deliver exceptional customer service to external and internal customers.
Answer incoming calls and handle inquiries related to scheduling and general information.
Ensure administrative and financial preparation of patients prior to their visit.
Oregon Health & Science University values a diverse and culturally competent workforce. They are an equal opportunity, affirmative action organization that does not discriminate against applicants.
Accountable for making decisions supported by policy based on confidential financial information both from the facility and from patients to determine qualification for CICP, Charity programs, or payment arrangements.
Verify coverage and authorization for all scheduled procedures through scheduling and registration information.
Act as a liaison between the patients, physicians, patient clinics, case management, centralized billing office, third party Medicaid eligibility vendor and community agencies.
CommonSpirit is accessible to nearly one out of every four U.S. residents. With our combined resources CommonSpirit is 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.
Lead the preparation and submission of comprehensive provider rosters to Managed Medicare, Medicaid, and commercial payers.
Audit internal provider data against database records to ensure 100% accuracy before submission.
Serve as the primary point of contact for health plans to resolve roster discrepancies, rejections, or paneling delays.
Privia Health is a technology-driven, national physician enablement company that collaborates with medical groups, health plans, and health systems. The Privia Platform consists of scalable operations and end-to-end, cloud-based technology that reduces unnecessary healthcare costs.
Ensuring providers are credentialed in a timely manner by monitoring the submission process.
Monitoring submission processes, updating protocols, and managing Virtual Assistants/BPO.
Communicating with payors and conducting regular reviews to validate internal credentialing data.
Grow Therapy aims to be the trusted partner for therapists growing their practice, and patients accessing high-quality care. They are a three-sided marketplace that empowers providers, augments insurance payors, and serves patients and have empowered more than ten thousand therapists.
Support clinical staff by gathering data to complete the medical necessity review process.
Create and send letters to providers and/or members to communicate information.
Collaborate with care management teams and stakeholders to provide optimal service.
Wellmark is a mutual insurance company owned by policy holders across Iowa and South Dakota, and they’ve built their reputation on over 80 years’ worth of trust. They are motivated by the well-being of their members, putting them first and committing to sustainability and innovation.
Responsible for economic credentialing and provider enrollment with contracted managed care and governmental plans.
Communicating provider participation information to internal and external customers.
Ensures compliance with regulatory agencies and maintains a working knowledge of statues and laws.
The West Virginia University Health System is West Virginia’s largest health system and the state’s largest employer. They have more than 3,400 licensed beds, 4,600 providers, 35,000 employees, and $7 billion in total operating revenues.
Conduct timely and accurate eligibility checks and benefit investigations through payer portals and phone outreach to ensure claims are submitted correctly from the start
Enter and monitor DME claims across multiple platforms, troubleshoot billing issues, and proactively follow up to reduce denials and accelerate reimbursement
Analyze explanation of benefits (EOBs) for errors, missing payments, or misapplied patient responsibility, then determine and execute the correct resolution path
Babylist is the leading registry, e-commerce, and content platform for growing families helping parents feel confident, connected, and cared for at every step. It has over $1 billion in annual GMV, and more than $500 million in 2024 revenue and is reshaping the $320 billion baby product industry.
Prepare and submit credentialing and enrollment packets.
Maintain accurate provider files and track expirations.
Provide assistance to the billing team during staff absences.
Modena Health and Modena Allergy & Asthma are leading medical practices specializing in allergy, asthma, and immunology care, with clinics across Southern California and Arizona and plans for national expansion. They are physician-led and technology-enabled, committed to transforming allergy care while advancing clinical research and expanding access to cutting-edge medicine.
Manage prior authorizations and related administrative paperwork.
Input patient information, medical records (CPT, ICD-10, HCPCS), and billing data into EMR/EHR systems.
Assist with processing insurance claims, verifying patient insurance information, and handling billing inquiries, concerns, and documentation.
Wing is redefining the future of work for companies worldwide. They aim to be a one-stop shop for companies looking to build world-class teams and place their operations on autopilot.
Acts as key point of contact for the processing of enrollment applications for all providers. Works with System Credentialing and local medical staff contacts. Responsible for completing the ongoing review and attestation of all Munson Healthcare provider enrollment records.
Munson Healthcare is northern Michigan’s largest healthcare system, with eight award-winning community hospitals serving over half a million residents.
Schedules/re-schedules patient appointments at the appropriate facility and fulfills customer needs to ensure customer satisfaction. Communicates regularly with assigned referring offices and appropriate sales representatives. Collect and enter patient demographic and insurance information as needed.
SimonMed Imaging is the fastest growing outpatient radiology practice in the Nation, committed to excellence and improving patient care with best-in-class technology.
Processes acute and post-acute inpatient medical or behavioral health and select intensive outpatient higher level of care requests through review of the submitted request and applicable clinical records
Collaborates with UM department staff, including Clinical Support Specialists and Medical Directors to make a final determination, and with Care Management staff on discharge planning and transition of care activities.
Identifies and refers members with complex needs to the appropriate population health and/or care management program.
Capital Blue Cross promises to go the extra mile for our team and our community. Our employees consistently vote us one of the “Best Places to Work in PA, and we foster a flexible environment where your health and wellbeing are prioritized.
Discuss insurance coverage with patients and explain financial obligations. Identify and enroll eligible patients in financial aid programs. Coordinate payment arrangements pre- and post-treatment and accurately document communications.
IVX Health is a national provider of infusion and injection therapy for individuals managing chronic conditions like Rheumatoid Arthritis, Crohn's Disease, and Multiple Sclerosis.
Answers calls and route all incoming correspondence to appropriate staff.
Maintains up to date patient health records in the Electronic Medical Record system and Vynca data systems.
Coordinates transportation for patient medical appointments with contracted transportation companies and payers.
Vynca is passionate about transforming care for individuals with complex needs and is focused on providing comprehensive care for more quality days at home.
Deliver comprehensive care navigation and access support for Sana members, ensuring they receive the right care at the right time, place, and cost.
Collaborate with cross-functional teams, including our virtual care practice and customer support, to provide seamless care navigation services.
Educate members on their care referral options, empowering them to make informed healthcare decisions.
Sana Benefits is building affordable health plans designed around Sana Care, their integrated care model connecting members with unlimited primary care and expert care navigation at no additional cost to them. They've compiled an innovative team with top talent from across the healthcare and technology industries to deliver engaging, modern, concierge-style healthcare for their members.
Address the needs of patients with a focus on customer support, coordination of logistics, and problem solving.
Schedule and coordinate the flow of work within or between departments to expedite project efficiencies and resolution to escalations.
Address and resolve assigned inquiries with a sense of urgency; Ensure timely closure of escalation cases using email, phone, or salesforce.com
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, who care deeply for our work and each other.