Reviews payor denials and audits for potential lost revenue and writes comprehensive appeal arguments using clinical criteria.
Functions as a hospital liaison with external third-party payors and works with Physician advisor team to facilitate appeals.
Monitors and reports payor trends to management, ensuring compliance with regulatory and accrediting requirements.
Jefferson Health is a nationally ranked not-for-profit health care system reimagining health care and higher education to create unparalleled value. With more than 65,000 employees, it serves patients through millions of encounters annually at 32 hospital campuses and over 700 outpatient locations in the greater Philadelphia region, Lehigh Valley, and southern New Jersey.
Review patient medical records to determine why claims are denied and prepare compelling appeal arguments using clinical evidence and regulatory guidelines.
Search for supporting evidence and analyze insurance denial trends to provide feedback to hospitals and executive leadership.
Ensure compliance with HIPAA regulations and demonstrate excellent written communication skills in crafting appeal letters and hearing testimony.
PAM Health provides specialty healthcare services through over 70 long-term acute care hospitals, rehabilitation hospitals, wound clinics, and outpatient physical therapy locations in 17 states. With a collaborative culture and a focus on compassionate care, the company employs a dedicated team committed to high-quality patient outcomes and professional growth.
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.
Provide effective and timely customer service for members, providers, and insurers regarding health care claims.
Ensure timely follow-up and organize health insurance paperwork and medical records.
Communicate status updates, negotiate with providers, and appeal claim denials on behalf of plan members.
Included Health is a healthcare company delivering integrated virtual care and navigation. They aim to raise the standard of healthcare for everyone, offering care guidance, advocacy, and personalized virtual and in-person care.