Investigate the root causes of insurance denials and pursue resolution through follow-up, corrected claims, reconsiderations, and appeals. Provide requested claim documentation, maintain accurate account records, reconcile daily activities, and communicate effectively with payors, colleagues, and other departments.
The strategist is responsible for developing and implementing population health strategies for commercial populations to improve clinical outcomes and affordability. They will design evidence-based clinical programs and partner with cross-functional teams to ensure alignment with enterprise goals and provider performance.
The strategist is responsible for developing and implementing population health strategies for ACA, Medicaid, and D-SNP populations to improve clinical outcomes. They will design evidence-based clinical programs, prioritize initiatives based on ROI, and collaborate across the health system to ensure regulatory and quality performance goals are met.
The representative is responsible for providing customer service to patients, including scheduling appointments, managing referrals, and maintaining patient demographics. They must also respond to inquiries via phone, chat, and written channels while meeting quality and performance standards.
The role supports the Coding and Documentation Quality Assurance team by performing internal audits, ensuring regulatory compliance, and managing corrective action plans. Additionally, the educator develops and presents training programs for clinical and billing staff to maintain accurate documentation and coding standards.
The analyst will identify and validate medical cost savings opportunities by analyzing claims data and partnering with internal teams and vendors. They are responsible for developing audit strategies, quantifying financial outcomes, and producing executive-ready reports on payment integrity performance.
The Senior IT Project Manager leads large, enterprise-wide projects from initiation to completion, ensuring they meet budget and business objectives. This role also coordinates cross-functional teams and drives organizational change management while mentoring less experienced staff.
The analyst is responsible for the design, build, testing, and maintenance of Epic software solutions tailored to organizational needs. This includes providing tier-2 support, resolving application incidents, and collaborating with subject matter experts to optimize workflows.
The coder is responsible for assigning accurate medical codes to inpatient, outpatient, and specialty records to ensure proper financial reimbursement. They must also resolve pre-bill edits and denials while maintaining up-to-date knowledge of regulatory coding guidelines.
