Audits client data and generates high quality recoverable claims for the benefit of Cotiviti and our clients.
Conduct advanced, strategic analysis of paid claims, uncovering critical audit insights that drive process improvements and enhance organizational knowledge.
Make determinations based on prior knowledge and experience of client contract terms with the likelihood of recovery acceptance.
Auditing to ensure new provider and care center information is accurate.
Conducting Care Center audits based on the number of providers.
Identifying, monitoring, and managing denial management trends.
Privia Health is a technology-driven, national physician enablement company. They collaborate with medical groups, health plans, and health systems to optimize physician practices and improve patient experiences. Their platform is led by industry talent and cloud-based technology.
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.
Be responsible for department quality audit process related to service standards, adherence to procedural, regulatory and financial requirements.
Review the referral of, submit, monitor and track all subrogation referrals receive by the Claim department and forwarded to external vendors.
Handle overpayment, check void and refunds, including maintenance of the overpayment log.
Berkley Accident and Health is a risk management company that designs innovative solutions to address the unique challenges of each client. With its entrepreneurial culture and a strong emphasis on analytics, they can help employers better manage their risk.
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.
Research and interpret payer policies in accordance with healthcare coding and regulatory requirements.
Identify common error areas that can be made into automated software logics that prevent overpayments.
Develop claims editing logics that promote payment accuracy and transparency across lines of business.
Rialtic is an enterprise software platform empowering health insurers and healthcare providers to run their most critical business functions. Founded in 2020 and backed by leading investors, they are tackling a $1 trillion problem to reduce costs, increase efficiency and improve quality of care.
Performs routine and complex audits on phone calls and claims adjudication.
Researches claim processing problems and errors to determine their origin and appropriate resolution.
Provides prompt customer service to members, providers, billing departments, and other insurance companies regarding claims.
University of Utah Health is an integrated academic healthcare system with five hospitals, community health centers, and a health plan. It is nationally ranked and recognized for academic research, quality standards and overall patient experience with over 1,600 providers.
Resolve participant claim issues by responding to questions and resolving tickets in our ticketing system.
Process client claims and service provider invoices in case management system accurately and ensures contractual and legislative requirements are met.
Provide quality assurance for claims/invoices processed by other Claims Specialists.
They partner with governments and local agencies across Canada to create sustainable employment opportunities for people, businesses and communities. They understand that work gives hope, strengthens relationships and drives economic growth.
Perform pre-call analysis and check the status by calling the payer or using IVR or web portal services.
Maintain adequate documentation on the client software to send the necessary documentation to insurance companies and maintain a clear audit trail for future reference.
Record after-call actions and perform post-call analysis for the claim follow-up.
TruBridge connects providers, patients, and communities with innovative solutions that create real value by supporting both the financial and clinical sides of healthcare delivery. They are a remote team that encourages their employees to push boundaries and look at things differently.
Document solutions in reusable articles to support future issue resolution
Experian is a global data and technology company, powering opportunities for people and businesses around the world. A FTSE 100 Index company listed on the London Stock Exchange (EXPN), they have a team of 23,300 people across 32 countries, with corporate headquarters in Dublin, Ireland.
Kodiak Solutions transforms the healthcare industry through technology-driven solutions, specializing in healthcare finance, unclaimed property, risk management, and revenue cycle management. With an innovative platform, they offer cloud-based systems, automated workflows, and advanced data management tools.
Assist in the processing and calculation of the practice portion estimates.
Prepare month-end reporting workbooks related to practice portion expense, including related journal entries and reconciliations.
Understand contract terms to ensure the distribution of monthly and/or quarterly payments to practice are in line with the contracts; serve as a liaison between Aledade Finance/Accounting and Aledade practices/markets to communicate payment distribution.
Aledade is empowering independent primary care practices. They were founded in 2014 and have grown to be the largest network of independent primary care in the US with a remote-first culture.
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 dedicated to providing high-quality anesthesia services. They offer equal employment opportunities to all employees and applicants.
The Hospital Contract Definition Analyst plays a critical role in the implementation and maintenance of hospital payer contracts within Experian Health's Contract Manager system.
You will ensure accurate modeling of reimbursement methodologies to support valuation of hospital claims and patient estimates and collaborate with senior team members to process new client implementations.
Independently manages routine maintenance cases, ensuring compliance with enterprise standards and client expectations.
Experian is a global data and technology company, powering opportunities for people and businesses around the world. A FTSE 100 Index company listed on the London Stock Exchange (EXPN), they have a team of 23,300 people across 32 countries where their corporate headquarters are in Dublin, Ireland.
Handle inbound and outbound calls to support our healthcare client.
Expected to deliver exceptional customer service by adhering to established protocols and guidelines.
Utilize various web-based systems to efficiently address and resolve customer inquiries.
Senture is a global company that embraces diversity and never discriminates against employees or applicants based on gender identity or expression, sexual orientation, race, religion, age, national origin, citizenship, disability, pregnancy status, veteran status, or other differences. They have employees from various backgrounds and lifestyles.
Work within Salesforce system to ensure integrity of data is clean
Complete specific payer forms when the Clinic has a change of demographics
Hanger, Inc. is the world's premier provider of orthotic and prosthetic (O&P) services and products, offering the most advanced O&P solutions, clinically differentiated programs and unsurpassed customer service. They have 160 years of clinical excellence and innovation, and their vision is to lead the orthotic and prosthetic markets by providing superior patient care, outcomes, services and value.
Ensure accurate Accounts Receivable positions via collections, credit, research & analysis.
Establish appropriate credit limits by analyzing DSO and external credit risk management tools.
Ensure prompt payment of assigned accounts through telephone, email, and written communication.
FUJIFILM Healthcare Americas Corporation innovates for a healthier world with cutting-edge healthcare solutions, including diagnostic imaging and in-vitro diagnostics. They have over 70,000 employees across healthcare, electronics, business innovation, and imaging, guided by their Group Purpose of “giving our world more smiles.”
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.
Maintains the practice management system by entering accurate data, verifying and updating insurance and claims information, handles carrier correspondence, manages EOBs, and keys payments received into the system.
Prepares, reviews, submits, and follows up with clean claims to various companies/individuals.
Collects, posts, and manages patient account payments.
US Anesthesia Partners provides comprehensive anesthesia care. They are committed to clinical excellence and outstanding patient experience.
Perform complex manual reconciliations between Product Activation logs, Salesforce records, and Billing Systems.
Investigate "Master Account" views to determine if products created in the accounts are currently billing or not.
Process and validate portions of a 7-8 million-line database, and record discrepancies where system integrations failed.
Coderoad is a software development company that provides end-to-end software development services. They offer opportunities to work on real-world projects in a supportive environment, focusing on staff augmentation, dedicated IT teams, and general software engineering.
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.