Review medically complex claims, pre-authorization requests, appeals, and fraud and abuse referrals.
Assess payment determinations using clinical information and established guidelines.
Evaluate medical necessity, appropriateness, and reasonableness for coverage and reimbursement.
Broadway Ventures transforms challenges into opportunities with expert program management, cutting-edge technology, and innovative consulting solutions. As an 8(a), HUBZone, and Service-Disabled Veteran-Owned Small Business, we empower clients with tailored solutions, operating with integrity and collaboration.
Investigate mental health benefits and verify eligibility, authorization, and insurance requirements via phone, portals, or fax.
Contact patients to clearly communicate cost estimates, financial options, and liability including copays, coinsurance, and deductibles.
Collaborate with front office, billing, and intake teams to resolve insurance issues and correct errors in the practice management system.
Mindpath Health is a national leader in mental health services, providing psychiatric and therapy services across six states via in-person and telehealth appointments. The team is deeply committed to compassionate, collaborative care and supporting total health.
Coordinate and oversee patient care requests, ensuring timely and compassionate responses.
Serve as the central point of contact throughout the patient journey.
Maintain accurate electronic medical records and coordinate medical testing and follow-up care.
This company provides patient-centered healthcare coordination, connecting patients with physicians and specialists. They are a mission-driven organization that values collaboration, professional growth, and a supportive, inclusive workplace.
Lead and develop a credentialing team, overseeing provider credentialing, licensing, and privileging processes.
Manage operational workflows, conduct audits, and implement improvements to ensure compliance and efficiency.
Collaborate with internal leadership, providers, and external clients to resolve issues and maintain high service levels.
Jobgether is an AI-powered recruitment platform that connects candidates with job opportunities through objective matching. It offers a fully remote, collaborative work environment with a focus on employee development and belonging.
Coordinate patient care plans and communication between patients, providers, and care teams.
Manage administrative tasks including EHR updates, referrals, insurance verification, and patient inquiries.
Advocate for patients through routine check-ins, care barrier resolution, and compliance with HIPAA.
SnappyCX provides patient care coordination and healthcare support services. They focus on delivering high-quality, empathetic care management while maintaining a remote and flexible work environment.
Partner with hospital leadership and clinical teams to analyze and optimize EHR clinical workflows.
Serve as a bridge between clinical operations and technology, translating needs into IT solutions.
Support system optimization, training, and cross-functional collaboration within the Healthcare IT team.
Intelligent Technical Solutions (ITS) is an MSP that provides healthcare IT services, partnering with hospital leadership to optimize EHR workflows. Emphasizing core values and cultural fit, the company offers comprehensive benefits and promotes from within.
Drive operational excellence across provider risk adjustment, HCC coding, and value-based care programs while overseeing coding services delivered by domestic and global teams.
Serve as the primary strategic lead and escalation point for health plan and provider clients, maintaining accountability for service quality and client satisfaction.
Manage, mentor, and develop diverse coding teams across locations, ensuring coding activities follow organizational standards and regulatory requirements.
Our partner is a company that drives operational excellence in healthcare through risk adjustment, HCC coding, and value-based care programs. They are a senior leadership focused organization that manages coding services with diverse teams, emphasizing quality and compliance.
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.
Conduct quality assurance and audit planning for the WTC Health Program, reviewing claims and analyzing data to identify trends and issues.
Research federal payer coverage policies and develop program policies and procedures, maintaining the health plan codebook.
Collaborate with clinicians and subject matter experts to support medical management and claims review, ensuring accurate application of medical coding standards.
Advanced Technologies & Laboratories International (ATL) provides expertise in quality assurance, claims processing, medical coding, and audit for the World Trade Center Health Program. The company offers a competitive total compensation package including paid leave, medical, dental, vision, and a 401(k) retirement plan.
Negotiate and manage budgets and contracts for clinical research studies.
Develop country and site budgets and track negotiation progress.
Ensure compliance with financial procedures and ICH GCP guidelines.
Fortrea is a clinical research organization dedicated to streamlining clinical trials and ensuring compliance with global regulations. The company fosters a collaborative, family-oriented culture with a focus on teamwork and excellence.