The Regulated Claims Settlement Coordinator supports the Claims Settlement Team through leading the review and response to disputed claims submitted through state and federal arbitration processes. The Regulated Claims Settlement Coordinator will be responsible for supporting Zelis' settlement offers and pricing after disputes have been filed to federal and state arbitrat

Inputs customer applications into the agency management system from the carrier rating system. Upload/submit application(s), photos, appraisals, etc. to be submitted to the insurance carriers for policy issuance. Checks new and renewal policies for accuracy in rating, typing and coverage. Ensure that these policies are delivered and/or mailed to the client. Monitors renew

Mass General Brigham Health Plan is an exciting place to be within the healthcare industry. As a member of Mass General Brigham, we are on the forefront of transformation with one of the world's leading integrated healthcare systems. Together, we are providing our members with innovative solutions centered on their health needs to expand access to seamless and affordable

Mass General Brigham Health Plan is an exciting place to be within the healthcare industry. As a member of Mass General Brigham, we are on the forefront of transformation with one of the world's leading integrated healthcare systems. Together, we are providing our members with innovative solutions centered on their health needs to expand access to seamless and affordable

Coordinates expirations with producers and/or account executive to obtain renewal and/or new business information. Keep producers fully informed of all important activities on their accounts. Meet weekly with producers to review upcoming renewals. Identifies policies requiring renewal attention for surplus lines or agency billed policies and sends carriers renewal changes

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

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

Reporting directly to the Finance Department, the successful candidate will be responsible for coordinating insurance activities, analyzing insurance data, ensuring compliance with regulations, and fostering effective communication between internal and external stakeholders. This role will report directly to the Controller and will interact with third party insurance brok

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

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

1. Elicits data and reporting requirements from hospital leadership, clinicians, and other staff, using interviews, document analysis, requirements workshops, site visits, use cases, scenarios, data analysis, task, and workflow analysis. 2. Queries and analyzes data from hospital systems such as our electronic medical record system (Epic), enterprise data warehouse (EDW),

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 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

SC Rehab Services Admin Fall River , MA Admin/Clerical Support Pay Grade SC011 Full time , Day shift , 40 8 30am 5 00pm Mon Friday Req # 74488 Work for One of the World's Best Hospitals! For Five Consecutive Years, Newsweek named Southcoast Health among the World's Best Hospitals (Charlton Memorial, St. Luke's, and Tobey). In addition, since 2018, Southcoast Health has be