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.
Demonstrates knowledge of basic audit skills and adheres to Internal Audit Standards and UPH Internal Audit policies and methodologies.
UnityPoint Health is committed to their team members and has been 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, and believe in equipping you with support and development opportunities to deliver an exceptional employment experience.
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.
Researches requests for review of resolvable claims from providers.
Compiles information related to member appeals that request an Executive Review.
Provides copies of necessary documents and submits information to the Appeals and Policy Manager for review.
PEHP Health & Benefits is a division of the Utah Retirement Systems that serves Utah’s public employees through competitively priced medical, dental, life, and long-term disability insurance plans on a self-funded basis. They embrace both a public mission and a commitment to creating customer value.
Audits FEP claims, customer service inquiries, member and group enrollment activities in accordance with Plan Incentive Program (PIP) guidelines.
Supports IA and SIU with assistance as needed.
Utilizes the internal SharePoint Audit tool to communicate findings and follow up assuring corrective action is taken and documented.
Capital Blue Cross is committed to going the extra mile for their team and community. It's why their employees consistently vote them one of the “Best Places to Work in PA.”
Enroll and revalidate doctors and facilities with payors.
Process applications for licensing, permits, certifications, insurances, and relevant credentialing documents.
Review incoming insurance correspondence and mail and maintain and update credentialing spreadsheets accordingly.
CHOICE is the largest provider of pediatric dental care in the Southwest United States. They pride themselves on delivering high quality care to children in their communities.
Serve as the subject matter expert in interpreting payer agreements.
Collaborate with the Provider Network Operations team to support the build of standard operating procedures.
Maintain reconciliation trackers to measure contract performance and support audit requests.
Aledade empowers independent primary care practices to deliver better care and thrive in value-based care. They are the largest network of independent primary care in the country, creating value-based contracts across various health plans.
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.