submission of claims to payers and manage the resolution of claim denials and underpayments. Oversee hiring, training..., such as finance, operations, credentialing and external vendors. Ensure effective billing solutions are in place to support a multi...
of denials verbally and in writing. They will also coordinate pending cases for a review determination with Health Solutions...Summary: The UM Reviewer serves as a contact and resource person to Health Solutions’ members for the utilization...
of all approvals and denials, and transfers all clinical questions and judgment calls to the pharmacist. The Pharmacy Technician... process. Maintains complete, timely and accurate documentation of all approvals and denials, and transfers all clinical...
for insurance denials to facilitate resolution and reimbursement. Participate in Medical Record Review processes and performance...
process. Responsibilities include: Maintaining complete, timely, and accurate documentation of all approvals and denials...
documentation of approvals and denials while transferring all clinical inquiries to a pharmacist. Schedule & Location: Fully.... Maintain complete, accurate, and timely documentation of approvals and denials. Transfer all clinical questions and judgment...
cycle team to ensure proper reimbursement. Identify and address billing errors, denials, and appeals, working closely...
of all approvals and denials, and transfers all clinical questions and judgment calls to the pharmacist. Remote Prior Authorization...
maintaining complete, timely, and accurate documentation of all approvals and denials and transferring all clinical questions... authorization processes. Accurately document approvals and denials. Transfer clinical questions to the pharmacist. Maintain...
. Assists with appealing prior authorization denials, retro authorization or other special cases Responsibilities...
. Looking for a stable 40 hours per week in a work-from-home role? Have Prior Authorization, adjudication, appeals, denials experience? Hold... prescribing habits of participating physicians. MUST HAVE EXPERIENCE MAKING THE DECISIONS FOR APPEALS AND DENIALS. ADJUDICATION...
., converting milligrams) May resolve issues of denials identified through adjudication, and follow-up claims in Point of Sale (POS...
of all approvals and denials, and transfers all clinical questions and judgment calls to the pharmacist. Remote Prior Authorization...
of all approvals and denials, and transfers all clinical questions and judgment calls to the pharmacist. Remote Prior Authorization...
, insurance verification, benefits, and referrals. The successful candidate will be adept at researching denials and submitting... inquiries from insurance companies as required. Research claim denials and prepare and submit appeals. Ensure accurate...
, insurance verification, benefits, and referrals. The successful candidate will be adept at researching denials and submitting... inquiries from insurance companies as required. Research claim denials and prepare and submit appeals. Ensure accurate...
and appeal authorization denials, providing additional documentation or clarification as needed. Compliance and Reporting...
of denials identified through adjudication, and follow-up claims in Point of Sale (POS) Maintains current knowledge of Medicaid...
resolve issues of denials identified through adjudication, and follow-up claims in Point of Sale (POS) Maintains current...
Description/Duties Gather and input charts and prior authorizations and print remits for Medicaid and insurance Check for denials daily...