CommuniCare Health Services

Manage real-time insurance claims by analyzing and approving adjudications while ensuring medical necessity guidelines are met. Coordinate with billing and prior authorization departments to resolve discrepancies and secure proper reimbursement from third-party payers.

Provide remote administrative, clinical triage, and care coordination support for telehealth providers and residents in various healthcare settings. Coordinate telemedicine services, monitor EMR for clinical results, and ensure high-quality customer experience and patient outcomes.

The specialist manages the prior authorization workflow for assigned facilities, submitting requests to insurance plans and following them to completion. They collaborate with billing and adjudication departments to resolve discrepancies and participate in the appeal process.

The Mobile Employee Life Cycle (HR) Manager will focus on professional recruitment to attract the right candidates and implement consistent, positive engagement efforts to build a team reflecting company values. Responsibilities also include ensuring regulatory legal compliance and implementing recognition programs to minimize turnover.