and payer related qualifications and criteria for patient reimbursements Remains current on payer reimbursements and industry... and relation conditions, sexual orientation, or gender identity), age (40 and older), disability, genetic information (including...
requirements to secure full insurance or government payer reimbursement Documents all required scheduling, financial clearance... is recorded For uninsured patients, identifies and verifies active payer sources for patients, or refers to financial...
, hospital departments and other outside parties in relation to patient accounts. Performs other duties as assigned. LICENSES... of medical terminology, ICD-9/CPT coding and third party payer insurance verification processes required. Must possess the...
: Continuously evaluates the appropriateness of hospital admissions, continued stays, and treatment plans in accordance with payer... in UR/UM practices, payer requirements, clinical guidelines, and regulations affecting utilization management Professional...
Overview: Presbyterian is seeking a Provider Enrollment Coordinator to process health plan payer provider enrollment... to provider enrollment processes, licensing agencies and payers. Assist department manager with delegated payer annual/quarterly...
admissions, continued stays, and treatment plans in accordance with payer guidelines and evidence-based practice Quality... improvement initiatives Education: Attains and maintains current knowledge in UR/UM practices, payer requirements, clinical...
medical strategy and clinical, patient/caregiver, payer and healthcare/market landscape Act as a guardian for high standards... economic interpretations Understanding of the US health care environment including the payer landscape, marketplace factors...
necessity. The individual also works to maintain third-party payer relationships. This includes, but is not limited.... This individual provides clinical oversight to the clinical denials team, ensuring payer contracts are being appropriately followed...
Overview Presbyterian is seeking a Provider Enrollment Coordinator to process health plan payer provider enrollment... to provider enrollment processes, licensing agencies and payers. Assist department manager with delegated payer annual/quarterly...
, continued stays, and treatment plans in accordance with payer guidelines and evidence-based practice Quality of Practice... initiatives Education: Attains and maintains current knowledge in UR/UM practices, payer requirements, clinical guidelines...
for the patient’s discharge plan and third party payer guidelines. Communicates with patient/family to ensure understanding... is aware of the plan of care and anticipated length of stay. Monitors patient’s plan of care and progress in relation...
Medical Ctr campus Overview You know that your job is about much more than gathering referral and payer information... established guest relation’s standards of professional behavior and confidentiality. Greets and directs patients, visitors...
will also involve overseeing the design, development, and execution of pharmacy programs that support payer and provider partnerships..., and fraud within the pharmacy reimbursement cycle. Develop and implement solutions to reduce costs for clients in relation...
to diagnose and solve root process, payer and communicate system issues impacting revenue cycle objectives Stay informed... base in relation to the insurance plans one plan at a time, so that in 6 months you are the subject matter expert...
: This position requires a working knowledge of third party payer regulations, medical terminology and CPT-4, ICD-10, and HCPCS coding... in relation to the physical demands detailed above. Salary Range: $28.07- $42.11 per hour...
and documentation in relation to established contracts and those in progress. KEY PERFORMANCE INDICATORS (KPI): Ensure ≥ 95... communication skills. Knowledgeable of payer and vendor contract management Good organizational and self-motivational skills...
/teaching as needed, in relation to the corresponding remote patient monitoring program. Travel between assigned locations... and federal entities, payer contracts etc. Possesses ability to communicate effectively, both verbally and in writing. Possesses...
to payer enrollment on payer contact spreadsheet. Treats patients and co-workers consistent with the NextCare Mission...: Understanding of contracting processes. Understanding of revenue cycle in relation to credentialing. Previous experience using...
, and validation of reimbursement from third party plans in relation to the hospitals negotiated fees and adherence to contract terms... regarding contractual variances along with payer issues to leadership and work with the Managed Care Contracting team to resolve...
with their current needs and desires. Maintains a working knowledge and relationship with community resources and payer benefits... and contract/regulation changes per payer guidelines, Medicare and Medicaid to facilitate appropriate reimbursement, education...