The FH authorization process is an essential function to FH's compliance with CMS regulations, NCQA standards, other applicable regulatory requirements, and customer expectations. The FH Authorization Coordinator serves to administer the FH prior authorization process as outlined in the Plan Member Handbook/Evidence of Coverage, departmental policies and procedures, and r

Manage incoming Bordereaux from program managers Review and ensure Bordereaux submitted have accurate template format Complete review of validation errors from Bordereaux ingestion, follow up with individual program managers for correction Ensure and maintain accurate data within the LOC, written and affiliate Bordereaux trackers Manage the LOC process Manage OFAC check p

Under the direction of the Associate Director, reviews medical record documentation to identify pertinent diagnoses and/or procedures that require coding. The Certified Professional Coder reviews medical records to assure accurate specificity of diagnoses, procedures, and appropriate reimbursement for professional and/or facility charges. Effectively utilizes ICD 10, CPT,

Prior Authorization Specialist hybrid after onsite training! Full Time 8am 4 30pm Job Ref 29384 Category Clerical & Administrative Support Location Emerson Hospital, 133 Old Road to Nine Acre Corner, Concord, MA 01742 Department Patient Access Schedule Full Time Shift Day shift Hours 8 00 4 30 Job Summary Reports to the Direct of Patient Access, the position serves as the

Process provider applications and revalidation applications through verifications, credentialing, and site visits Accurately input enrollment data into database system Conduct quality assurance functions to reduce errors and improve processes and performance Demonstrate great depth of knowledge / skills in own function and act as a technical resource to others Educate and

At Boston Children's Hospital, the quality of our care and our inclusive hospital working environment lies in the diversity of our people. With patients from local communities and 160 countries around the world, we're committed to reflecting the spectrum of their cultures, while opening doors of opportunity for our team. Here, different talents pursue common goals. Voices

Under general supervision of the Claims Administration Follow up Supervisor perform all clerical duties necessary to properly process patient bills to customers taking appropriate follow up steps to obtain timely reimbursement of each 3rd party claim and ensure the financial stability of the Hospital. Responsibilities Consistently applies the corporate values of respect h

Are you a current UMass Memorial Health caregiver? CLICK HERE to apply through your Workday account. Schedule Details Monday through Friday Scheduled Hours 0800 1630 Shift 1 Day Shift, 8 Hours (United States of America) Hours 40 This position may have a signing bonus available a member of the Recruitment Team will confirm eligibility during the interview process. Everyone

Under the general direction of PFC Manager, the Outpatient Financial Counselor (OPFC) has a dual role to help vulnerable BMC patients to access healthcare coverage and to preserve and protect BMC revenue by securing payors to reduce uncompensated care. The OPFC serves as an advocate and navigator, assisting low income, uninsured and underinsured patients apply for financi

What does a Prior Authorization Specialist do? The Prior Authorization Specialist (PAS) is an essential role responsible for facilitating exceptional patient experience, by securing authorizations for all scheduled services related to medical and surgical admissions across entities, including BWH OR procedures, BWFH OR procedures, FXB OR procedures and BWH/BWFH Endoscopy