- Molina Healthcare (Columbus, OH)
- …State regulations, NCQA guidelines, and CMS standards. + Provides coordination and processing of pharmacy prior authorization requests and/or appeals . + Explains ... member and providers with initiating oral and written coverage determinations and appeals . + Records calls accurately in call tracking system. + Maintains specific… more
- US Tech Solutions (May, OK)
- …volume where needed. **Responsibilities:** Utilizing multiple software systems to complete Medicare appeals case reviews Meeting or exceeding government mandated ... include but not limited to: outbound calls, reviewing and processing Prior Auth's received via fax and ePA, monitoring...clients or lines of business and in accordance with Medicare Part D CMS Regulations. Must apply information provided… more
- Elevance Health (FL)
- …and personalized support throughout the consumer's treatment journey._ **Authorization Representative II** **Location:** This position will work a hybrid model ... or days may be required based on operational needs. **The Authorization Representative II** is responsible for the administration of prior authorizations requests… more
- Granville Health System (Oxford, NC)
- …to servicing outstanding patient accounts and possible overpayments.# Responsible for processing patient and insurance credit balances timely for resolution.# and ... processing refunds according to the Hospital policy.# Reviews insurance...policy.# Reviews insurance overpayments for accuracy and determines if appeals are needed.# Files bankruptcy claims and appropriately adjusts… more
- Granville Medical Center (Oxford, NC)
- …to servicing outstanding patient accounts and possible overpayments. Responsible for processing patient and insurance credit balances timely for resolution. and ... processing refunds according to the Hospital policy. Reviews insurance...policy. Reviews insurance overpayments for accuracy and determines if appeals are needed. Files bankruptcy claims and appropriately adjusts… more
- UNC Health Care (Smithfield, NC)
- …teamwork and reflects UNC Health Care's mission and philosophy. Responsibilities: 1. Appeals & Managed Care Escalations: Project Manage all 3rd party appeals ... Cosmetic & Elective account agreements to ensure accurate postings and processing by carriers. Troubleshoots self-pay payment issues including credit card… more
- US Anesthesia Partners (Austin, TX)
- Overview The Accounts Receivable Representative II is responsible for collecting outstanding accounts receivable from third party payers; both government and ... on outstanding claims. + Process and follow up on appeals to insurance companies. + Refile s claims as...Understanding of Medical terminology. + Advanced knowledge of insurance processing , guidelines, laws, and EOBs. + Knowledge of managed… more
- Peachtree Orthopedics (Atlanta, GA)
- …8:00am - 5:00pm Job Type: Full-time Your Impactful Role As a Patient Account Representative , you will play a crucial role in our healthcare team, managing accounts ... receivables, resolving past-due accounts, and ensuring efficient claims processing . Join us to make a meaningful impact in healthcare and advance your career. +… more
- Cardinal Health (Columbus, OH)
- …of the patient and/or program. + Resolve patient's questions and any representative for the patient's concerns regarding status of their request for assistance. ... notes as to what appropriate action is needed for the Benefit Investigation processing . + Working alongside teammates to best support the needs of the patient… more
- University of Rochester (Rochester, NY)
- …to obtain maximum revenue collection. Researches, corrects, resubmits claims, submits appeals , and takes timely and routine action to resolve unpaid claims. ... Excel, Access, Email, Emdeon (Fidelis Medicaid Managed Care and Medicare Part B) clearinghouse software, third party claims systems...on the appropriate payer system or contact an insurance representative to obtain information as to why claims are… more
- Elevance Health (Denver, CO)
- …and personalized support throughout the consumer's treatment journey._ **Authorization Representative I** **Location:** This position is on site converting to ... or days may be required based on operational needs. The **Authorization Representative II** is responsible for the administration of prior authorizations requests… more
- City of Alpharetta, Georgia (Alpharetta, GA)
- …The list of essential functions, as outlined herein, is intended to be representative of the tasks performed within this classification. The omission of a function ... stop work orders, etc. + Testifies in court or at Board of Zoning Appeals on code violations. + Takes, investigates, and finds solutions for Department of… more
- Cardinal Health (Columbus, OH)
- …documenting patient medical health insurance benefit investigations, prior authorizations, and appeals , preferred + Knowledge of Medicare , Medicaid and ... notes as to what appropriate action is needed for the Benefit Investigation processing + Working alongside teammates to best support the needs of the patient… more
- State of Colorado (Lakewood, CO)
- …engagement, implements and follows the facility Behavioral Management Program. Conducts processing and/or psycho-educational groups as needed to support a safe ... CBI name check and fingerprint check. ICON Colorado court database. Medicare fraud database. Reference checks. Professional License Verification (if applicable).… more
- State of Colorado (Denver, CO)
- …orders and contracts when the need arises. + Assists teams with invoice processing as needed. Program Support. + Assists assigned programs with duties to include: ... (non-direct contact): CBI name check, ICON Colorado court database, Medicare fraud database, Reference checks, Professional License verification (licensure… more
- State of Colorado (Denver, CO)
- …protected health information and other duties as assigned. Job Duties: Patient Info Processing : This position will engage in daily review of various reports such as ... check including CBI name check, ICON Colorado court database, Medicare fraud database, Reference checks, Professional License verification (licensure requirements),… more
- State of Colorado (Lakewood, CO)
- …or knowledge of the action: Colorado State Personnel Board/State Personnel Director, Attn: Appeals Processing , 1525 Sherman Street, 4th Floor, Denver, CO 80203. ... in the case of healthcare facilities, CMS (Centers for Medicare and Medicaid) mandated requirements. To accomplish this purpose,...Procedures, 4 CCR 801, for more information about the appeals process. The State Personnel Board Rules and Personnel… more
- Lancaster General Health (Lancaster, PA)
- …and on-call coverage provided by the LGHP Hospitalists at LRH, serving as representative of the LGHP Hospitalists practice. The Associate director will report to ... formulary chairing Pharmacy and Therapeutics committee + Act as a representative and goodwill ambassador for LRH to patients, families, practitioners, and… more
- LA Care Health Plan (Los Angeles, CA)
- …Oversee overtime work and will produce accurate accounting of each representative work performance. Conducting evaluations of and implementing enhancements to the ... Procedure Coding System (HCPCs) codes. Technical Support to UM Specialist: Processing of time sensitive authorization and pre-certification requests to meet… more
- e CancerCare (Nashville, TN)
- …Recognizing their importance and relationship to patient care. Consults with appeals department for disputed medical necessity denied claims. Works and Understands ... and resources to support account resolution activities. Ensures that all processing and reporting deadlines are consistently achieved. Adhere to all standard… more