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.
Support the Care Advice Line call queue after hours, weekends, and holidays, answering calls promptly and accurately.
Triage and transfer calls to RNs, providers, or 911 as needed, while charting in EMR and maintaining patient communications.
Provide patient education, referrals, and scheduling assistance to support care coordination and proactive health management.
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 physician leadership, focusing on reducing healthcare costs and improving outcomes.
Support the Clinical Quality team through project-based deliverables and operational tasks.
Lead an end-to-end overhaul of the provider resource library, including auditing and refreshing content.
Provide weekly operational support including triaging tickets, preparing reports, and coordinating quarterly planning.
Maven is the world's largest virtual clinic for women and families, providing clinical, emotional, and financial support through a digital platform. With over 2,000 employer and health plan clients and more than $425 million in funding, Maven has been recognized as a top workplace and innovator.