Contacts insurance carriers / patients regarding outstanding insurance claims to obtain proper payment based on EOB and / or Experian contract modeling expectations. Knowledge of clinic operating policies to help in the identification of denial root causes. Prepares proper documentation for appeals to insurance carriers. Processes the appealing of claims reimbursed incorr

Demonstrate understanding of a provider's business goals, contracting, performance metrics/scorecard, industry trends, and WellMed business model Coaches and provides the translation of financial data to guide action. Assist with contracted and affiliated efforts Market contracting strategy Assist PBMs with financial education, meeting presentations, and identifying areas

Greets patients as they arrive and manage appropriate standard wait times Complete check in and check out tasks to include insurance verification, complete pre authorizations and/or precertification of procedures, and copy required documents Collects co payments, co insurance, and deductibles and issues receipts Manages cashier box and daily deposits according to company

Conduct a high volume of outbound calls to members to discuss reasons for non compliant to medication(s), schedule pharmacy telephonic appointments, and/or obtain important follow up information from providers. Outbound calls are made primarily using an auto dialer requiring precision to detail and adaptability to type of response needed May answer inbound calls from memb

Greets patients as they arrive and manage appropriate standard wait times Complete check in and check out tasks to include insurance verification, complete pre authorizations and/or precertification of procedures, and copy required documents Collects co payments, co insurance, and deductibles and issues receipts Manages cashier box and daily deposits according to company

Performs all duties within the scope of a Medical Assistant's practice. Operates diagnostic equipment (cannot interpret tests), remove staples from superficial wounds, changes wound dressing and obtains cultures, administers non intravenous medication, performs simple specimen collection via noninvasive techniques and collects blood specimens via venipuncture or via capil

Performs all duties within the scope of a Medical Assistant's practice. Operates diagnostic equipment (cannot interpret tests), remove staples from superficial wounds, changes wound dressing and obtains cultures, administers non intravenous medication, performs simple specimen collection via noninvasive techniques and collects blood specimens via venipuncture or via capil

Conduct a high volume of outbound calls to members to discuss reasons for non compliant to medication(s), schedule pharmacy telephonic appointments, and/or obtain important follow up information from providers. Outbound calls are made primarily using an auto dialer requiring precision to detail and adaptability to type of response needed May answer inbound calls from memb

Implements and leads all aspects of Caregiver SOS in an assigned geographic area, including oversight of assistants and volunteer staff Develops an annual business plan with measurable objectives, and targeted activities to achieve those objectives Builds relationships and collaborates with key leaders, professionals, organizations and other stakeholders that serve caregi

Implements and leads all aspects of Caregiver SOS in an assigned geographic area, including oversight of assistants and volunteer staff Develops an annual business plan with measurable objectives, and targeted activities to achieve those objectives Builds relationships and collaborates with key leaders, professionals, organizations and other stakeholders that serve caregi

Performs all duties within the scope of a Medical Assistant's practice. Operates diagnostic equipment (cannot interpret tests), remove staples from superficial wounds, changes wound dressing and obtains cultures, administers non intravenous medication, performs simple specimen collection via noninvasive techniques and collects blood specimens via venipuncture or via capil

Provides consistent professional nail care to include trimming and buffing of toenails Organizes exam and treatment rooms, replenishes stock levels, cleans rooms and sterilizes medical instruments Keeps inventory of supplies and places replenishment orders as needed Returns any and all patient messages in a timely manner Attends, participates in and supports training and

Supports case management operations across the continuum of care (assessing, planning, implementing, coordinating, monitoring, and evaluating) Oversees care management functions and ensure compliance with application of criteria from approved standardized guidelines, government mandated regulations and contractual agreements, to include NCAQ, URAC, and CMS Engages in Care

Develop market business plans to motivate providers to engage in improving Stars measures to be 4 STARS or higher Provide analytical interpretation of Stars and HEDIS reporting, including executive summaries to plan and provider groups Be the primary go to person for all STARS related activities within their assigned market(s) working within a matrix relationship which in

Independently collaborates effectively with Interdisciplinary care team (ICT) to establish an individualized transition plan for members Independently serves as the clinical liaison with hospital, clinical and administrative staff as well as performs a review for clinical authorizations for inpatient care utilizing evidenced based criteria within our documentation system