Support Director of Healthcare Policy and Reimbursement in fielding and responding to coding, coverage, and reimbursement internal inquiries and providing policy research assistance.
October 12, 2022
Manages the centralized identification, correction, and research of third party exceptions, and recommends operational changes necessary to reduce rejects, audit losses and overpayments from Third Party plans.
October 30, 2022
Provide PRC approved information related to product coverage, which may include payer specific requirements for claims processing, information regarding prior authorizations and the appeals process, as well as general information regarding disease state.
December 22, 2022
Monitor, assess, and report provider, payer, and legislative regional trends and developments to support strategic and tactical planning in assigned territories.
January 15, 2023
Reviewing patient-specific information in cases where the site has specifically requested the assistance and patient health information is available in resolving any issues or coverage challenges.
January 24, 2023
Assist in improving productivity, consistency, and quality across all reimbursement and affordability programs through audit, appropriate service level agreements (SLAs) with internal and external partners.
February 14, 2023
Demonstrate extensive knowledge of specialty payer landscape, the appropriate utilization of NCCN/ASCO guidelines, private payer, GPOs, Medicare and Medicaid structure, Specialty Pharmacy systems and reimbursement processes and the general evolution of the healthcare landscape.
February 23, 2023
Acts as the first point of contact for escalation issues from the service provider regarding unresolved unknown deductions on payments received from payer or failure of payer to comply with contract terms as well as for billing and collections issues/ claims.
March 03, 2023
Communicates regularly with decision support, financial reporting, hospital departments, health information management (HIM), clinicians, UM School of Medicine, and others to ensure compliance of all regulations and optimal effectiveness of financial reporting.
March 22, 2023
Maintains positive and cooperative communications and collaboration with all levels of employees, customers, contractors, and vendors.
April 27, 2023