Manage and track all stages of the claims process for non contracted and contracted payors Generate accurate insurance claims in a timely manner Proactively follow up on claim status Review Explanation of Benefits statements and take appropriate action via verbal or written appeal to challenge low payments and various denials Ensures claims are paid according to contractual agreements Serve as a r

Contacts insurance carrier(s) to obtain all information necessary for the successful billing of 3rd party payers (coordination of benefits, benefit coverage / limits, co pay / deductible amounts, authorization, pre certification and referral requirements, etc. Re verifies insurance of recurring patients Advises patient of all financial obligations Communicates balance amounts, deposits and point o

Partner with key stakeholders to develop and execute operational and strategic client plans that addresses the client’s business needs Understand and translate key client business challenges tied to value based care and/or acute care delivery into potential analytic solutions to support those business challenges Lead and conduct analysis designed to identify root causes and produce cogent re

Make contacts to schedule a variety of specific medical and dental services in accordance with customer availability and contract guidelines. Respond to a variety of inquiries and resolves issues with regard to the appointment scheduling / fulfillment processing and service completion in a timely manner while maintaining sensitivity toward military culture Conduct customer contacts related to Heal

Prepare examination rooms and sterilizing equipment Room patients, obtain health history, check vital signs and perform EKG’s Administer injections and collect specimens Document patient care using NextGen electronic medical record software Schedule appointments, complete prior authorizations, process medication refills, handle referrals, answer calls and complete paperwork Assist physicians

Research and analyze the data and processes associated with quality measure data from existing EMR platform which feed the supplemental data process. Understand HEDIS and NCQA technical specifications and apply measure criteria Collaborate with internal analytics teams to understand clinical quality data flows create alignment on data analytics methodologies used, identify and resolve data issues

Demonstrate respect for patients and ProHealth staff by presenting a friendly, courteous manner at all times and maintaining patient confidentiality Greet and assist patients as they enter the practice by providing directions, answering patients’ questions and escorting patients when needed Assist Medical Receptionist with duties as needed such as answering calls, scheduling appointments, fi

Project Discovery & Customer Experience Management Collaborate and consult with subject matter experts (SMEs) Communicate proactively to provide project status updates to supervisor and SMEs Project Management Create project plan and ensure your tasks are delivered on schedule and within scope Manage project within established scope, timeline and quality standards Design & Development Work

Assess, screen, triage and perform treatment ordered for patients Perform medical treatment as ordered by provider or established MedExpress standing orders Prepare and assist provider with dispensing prescribed medications (in states where applicable) Assist the provider with examinations, procedures and other duties Oversee and coordinate the daily patient care flow Assist patients as needed wi

Educate providers to ensure that they have the tools they need to meet quality, risk adjustment, growth (as appropriate), and total medical cost goals per business development plans facilitated through strategic meetings. Ensure providers have in depth understanding of OptumCare model to include, but not limited to, patient care best practices, contractual obligations and program incentives. Cond

Ability to identify operational challenges and/or opportunities by analyzing the available data and develop and execute plans to fix problems and take advantage of new business opportunities Manage with persistence and is driven by big challenges and has the ability to drive strategies to scale operations quickly / as needed High level attention to detail, ability to multitask, highly organized Ex

Advise patients on alternate Rx fill strategies of retail versus mail order and options for financial assistance Review medical case notes to determine on going medication treatment plan and project future medication costs Work is frequently completed without established procedures Applies knowledge/skills to a range of moderately complex activities Proactively identifies solutions to non standard

Inputs invoices into the accounting financial system. As assigned, reconciles and documents vendor accounts which include interacting with the vendor representation. Coordinates new vendor onboarding with multiple departments. Researches and trouble shoots Accounts Payable questions or issues. Cross trains on all key responsibilities across accounts payable functions. Adhere to Accounts Payable pr

Assist in opening and closing the clinic, locking and unlocking the doors and maintaining a clean waiting area Welcome all On Site Clinic patients and visitors by greeting them with a friendly demeanor, answering inquiries and directing them through the registration process Answer multi phone lines, filing, faxing, scanning documentation and completing daily patient callbacks Collect all insurance

USMD Oncology Virtual Career Event, January 21, 11 00 AM 1 00 PM CT Do you have compassion and a passion to help others? Transforming healthcare and millions of lives as a result starts with the values you embrace and the passion you bring to achieve your life's best work.(sm) The Patient Services Representative is a critical part of the oncology clinic and helps set the tone for a patients visit