Eligibility Review: Review patient records and clinical documentation to determine eligibility for Form Health.
Record Collection: Manage requesting, faxing, and tracking medical records from external providers while ensuring HIPAA compliance.
File Communication: Maintain clear communication with patients and colleagues to keep them updated throughout the eligibility process.
Form Health is a virtual obesity medicine clinic that provides multi-disciplinary evidence-based obesity treatment through telemedicine. Founded in 2019, it is a venture-backed startup with an experienced clinical and leadership team, committed to a culture of inclusion and patient-first values.
Lead portions of regulatory assessments, external audits, and accreditation processes for Commercial, Medicare, Medicaid, and Marketplace departments.
Act as primary point of contact for internal and external partners on regulatory activity, quality efforts, SOP development, and client delegation agreements.
Maintain regulatory gap status reporting, track work streams, and lead change management related to regulatory requirements.
Prime Therapeutics is a pharmacy benefit manager (PBM) with a purpose beyond profits, reimagining pharmacy solutions to connect care for those they serve. The company is a large, purpose-driven organization focused on simplifying healthcare and fostering a collaborative culture.
Review patient records and clinical documentation to determine eligibility accurately.
Communicate with patients, clinicians, and providers to ensure a smooth onboarding process.
Maintain records in EMR systems and manage multiple cases simultaneously.
Our partner is a healthcare organization focused on improving patient access to specialized services. They operate with a remote, patient-focused team committed to efficient and compassionate care delivery.
Interpret Medicaid regulatory, Program Integrity, and Third-Party Liability (TPL) requirements to support compliance assessments and audit readiness.
Develop recommendations and corrective action approaches to address compliance findings and support responses to CMS and state agencies.
Collaborate with cross-functional teams to align findings, prioritize follow-up activities, and coordinate recommendations for process improvements.
BerryDunn is a client-centered, people-first professional services firm that has helped businesses, nonprofits, and government agencies since 1974. With a focus on creating a diverse and inclusive workplace, the firm is recognized for its commitment to learning, development, and well-being.
Leverage state and federal Medicaid policy expertise to help agencies implement new programs and manage compliance.
Analyze regulations and sub-regulatory guidance to inform program direction and manage project initiatives.
Partner with the team to share Medicaid expertise and support client needs while driving team development.
BerryDunn is a professional services firm providing tax, advisory, and consulting services to businesses, nonprofits, and government agencies. Founded in 1974, the firm has a client-centered, people-first culture and has been recognized for its diversity and inclusion efforts.
Conducts baseline, routine, and focused audits comparing medical record documentation to reported CPT/HCPCS and ICD-10-CM codes.
Researches, interprets, and communicates federal and state laws and guidelines pertaining to CMS and Medicare.
Acts as an internal expert on coding issues to ensure compliance with state and federal regulations.
Privia Health is a technology-driven national physician enablement company that collaborates with medical groups, health plans, and health systems to optimize physician practices and improve patient experiences. The company is led by top industry talent and focuses on scalable operations and cloud-based technology to reduce healthcare costs.
Perform complete, accurate, and timely processing of reimbursement/payment audits in compliance with policies, payer contracts, and government fee schedules.
Collaborate with operations consultants, RCM AR staff, and management to address Care Center payment performance audits and maximize cash flow.
Identify, monitor, and manage denial management trends, and work closely with Revenue Cycle Teams and payer representatives.
Privia Health is a technology-driven, national physician enablement company that collaborates with medical groups, health plans, and health systems to optimize physician practices and improve patient experiences. The company is led by top industry talent and exceptional physician leadership, focusing on reducing healthcare costs and improving outcomes.
Perform medical claims audit reviews with a focus on the Home Health sector, applying medical review guidelines and documenting findings.
Collaborate with the audit team to identify vulnerabilities, generate audit letters, and support findings during appeals.
Maintain knowledge of coding systems (ICD-10, CPT-4, HCPCS) and regulatory changes to ensure high-quality, deadline-driven work.
Machinify is a leading healthcare intelligence company that delivers value, transparency, and efficiency to health plan clients using an AI-powered platform. Deployed by over 85 health plans, including many of the top 20, and representing more than 270 million lives, the company fosters a collaborative, fast-paced remote culture.
Analyze Medicaid claims, encounter, and program data to identify trends and risks.
Support fraud, waste, and abuse and payment integrity initiatives through analysis and research.
Translate complex findings into clear recommendations for decision-makers.
BerryDunn is a professional services firm providing tax, advisory, and consulting services to businesses, nonprofits, and government agencies. They have been recognized for their inclusive culture and focus on employee well-being.
Performs clinical evaluations on disability claims to substantiate medical necessity for absence.
Communicates with employees and providers to discuss clinical status and provides follow-up recommendations.
Acts as a clinical resource to claims examiners, ensuring accurate medical terminology and claim decisions.
Sedgwick is the world's leading risk and claims administration partner, helping clients navigate the unexpected with AI-enabled technology and expertise. With over 33,000 colleagues and 10,000 clients across 80 countries, they've been recognized as a Great Place to Work and offer a caring culture.
Verify patient eligibility and analyze Medicaid claim payments to ensure proper reimbursement.
Review UB-04 billing components and prepare initial Medicaid bill packets with supporting documentation.
Conduct timely follow-up with payers, manage authorizations, and appeal denials as needed.
EnableComp provides specialty revenue cycle management solutions for healthcare organizations, using intelligent automation to improve financial sustainability for hospitals and health systems. Recognized as a Top Workplaces recipient and among the Inc. 5000 fastest-growing private companies for eleven years, the company fosters a family-oriented culture focused on employee growth.
Work one-on-one with MassHealth members to complete applications and renewals, gather documents, and resolve eligibility issues.
Own patient cases from start to finish, supporting renewal campaigns and helping patients understand notices.
Spot patterns in patient issues and bring insights to the product team to improve our technology.
BridgeHealthAI builds technology for the healthcare safety net, working with community health centers to help patients maintain health coverage. We are a small, fast-moving team founded out of Harvard and MIT, backed by Pear VC and Flare Capital, focused on healthcare, AI, and health equity.
Conducts redetermination reviews in compliance with Medicare rules.
Responds to appeals and writes professional correspondence.
Researches claims issues and submits educational referrals.
Broadway Ventures transforms challenges into opportunities with expert program management, cutting-edge technology, and innovative consulting solutions. As a small business focused on government and private sector clients, they foster integrity, collaboration, and excellence.
Screen patients remotely to understand eligibility for benefit programs like LIHEAP, SNAP, and Lifeline.
Complete Lifeline applications end-to-end, including submission via the FCC website or state-specific processes.
Track all activity and enrollment metrics in the Link Health dashboard while ensuring privacy compliance.
Link Health assists individuals and families in navigating and enrolling in government assistance programs to address social determinants of health. It is a community-centered organization leveraging data, technology, and partnerships to connect underserved populations with benefits.
Perform daily audits of RCM accounts to ensure accuracy and compliance with policies.
Review documentation, billing records, and account activity to identify errors and process gaps.
Communicate quality issues and provide constructive feedback to staff and department leaders.
Our partner focuses on revenue cycle management services for healthcare organizations. They foster a remote culture centered on accuracy, accountability, and continuous improvement, with a team dedicated to quality and compliance.
Manage forensic review, investigative, and provider audit activities related to Medicaid medical, dental, behavioral health, pharmacy claims, as well as provider, member, financial, audit, TPL, and operational data.
Lead identification, documentation, and escalation of potential fraud, waste, abuse, or non-compliance risks, and review Medicaid claims for accuracy and compliance with policies.
Develop corrective action recommendations and follow-up plans to address identified fraud, waste, abuse, improper payment, compliance, claims, or operational issues.
BerryDunn is a client-centered, professional services firm that helps businesses, nonprofits, and government agencies solve challenges. The firm is led by CEO Sarah Belliveau, known for its inclusive workplace culture and focus on learning and well-being.