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Privacy Policy

Privacy Policy

THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.
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The Health Insurance Portability and Accountability Act of 1996 (HIPAA) is a federal program that requires that all medical and dental records and other individually identifiable health information used or disclosed by us in any form, whether electronically, on paper or orally, are kept properly confidential. This Act gives you, the patient, significant new rights to understand and control how your health information is used. HIPAA provides penalties for covered entities that misuse Protected Health Information (PHI).
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This Notice of Privacy Practices describes how we may use and disclose your Protected Health Information (PHI) to carry out treatment, payment or health care operations (TPO) and for other purposes that are permitted or required by law. It also describes your rights to access and control your protected health information. "Protected health information" is information about you, including demographic information, that may identify you and that relates to your past, present or future physical or mental health or condition and related health care services.
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Uses and Disclosures of Protected Health Information
Your Protected Health Information may be used and disclosed by your physician, our office staff and others outside of our office that are involved in your care and treatment for the purpose of providing health care services to you, to pay your health care bills, to support the operation of the practice, and any other use required by law.
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Treatment: We will use and disclose your Protected Health Information to provide, coordinate, or manage your health care and any related services. This includes the coordination or management of your health care with a third party. For example, your protected health information may be provided to a physician to whom you have been referred to ensure that the health care professional has the necessary information to diagnose or treat you.
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Payment: Your protected health information will be used, as needed, to obtain payment for health care services. For example, obtaining approval for a hospital stay may require that your relevant protected health information be disclosed to the health plan to obtain approval for the hospital admission.
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Healthcare Operations: We may use or disclose, as-needed, your protected health information in order to support the business activities of your physician’s practice. These activities include, but are not limited to, quality assessment activities, employee review activities, and conducting or arranging for other business activities. We may use or disclose, as needed, your protected health information to support the business activities of this practice. In addition, we may use a sign-in sheet at the registration desk where you will be asked to sign your name and indicate your physician. We may also call you by name in the waiting room when your physician is ready to see you. We may use or disclose your protected health information, as necessary, to contact you to remind you of your appointment. We may call your home and leave a message (either on an answering machine or with the person answering the phone) to remind you of an upcoming appointment, the need to schedule a new appointment or to call our office. We may also mail a postcard reminder to your home address. If you would prefer that we call or contact you at another telephone number or location, please let us know.
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We may use or disclose your protected health information in the following situations without your authorization. These situations include: as Required By Law, Public Health issues required by law, Communicable Diseases: Health Oversight: Abuse or Neglect: Food and Drug Administration requirements: Legal Proceedings: Law Enforcement: Coroners, Funeral Directors, and Organ Donation: Research: Criminal Activity: Military Activity and National Security: Workers’ Compensation: Inmates: Required Uses and Disclosures: Under the law, we must make disclosures to you and when required by the Secretary of the Department of Health and Human Services to investigate or determine our compliance with the requirements of HIPAA.
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Other Permitted and Required Uses and Disclosures Will Be Made Only With Your Consent, Authorization or Opportunity to Object unless required by law.
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You may revoke this authorization, at any time, in writing, except to the extent that your physician or the physician’s practice has taken an action in reliance on the use or disclosure indicated in the authorization.
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Your Rights
The Following is a statement of your rights with respect to your protected health information.
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You have the right to inspect and copy your protected health information. Under federal law, however, you may not inspect or copy the following records; psychotherapy notes; information compiled in reasonable anticipation of, or use in, a civil, criminal, or administrative action or proceeding, and protected health information that is subject to law that prohibits access to protected health information.
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You have the right to request a restriction of your health information. This means you may ask us not to use or disclose any part of your protected health information for the purposes of treatment, payment or healthcare operations. You may also request that any part of your protected health information not be disclosed to family members or friends who may be involved in you care or for notification purposes described in this Notice of Privacy Practices. Your request must state the specific restriction and to whom you want the restriction to apply.
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Your physician is not required to agree to a restriction you may request. If your physician believes it is in your best interest to permit use and disclosure of your protected health information, your protected health information will not be restricted. You then have the right to use another Healthcare Professional.
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You have the right to request to receive confidential communications from us by alternative means or at an alternative location. You have the right to obtain a paper copy of this Notice from us, upon request, even if you have agreed to accept this Notice alternatively (i.e. electronically).
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You may have the right to have your physician amend your protected health information. If we deny your request for amendment, you have the right to file a statement of disagreement with us and we may prepare a rebuttal to your statement and will provide you with a copy of any such rebuttal.
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You have the right to receive an accounting of certain disclosures we have made, if any, of your protected health information.
We reserve the right to change the terms of this Notice and will inform you of any changes. You then have the right to object or withdraw as provided in this Notice.
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Complaints
You may complain to us or to the Secretary of Health and Human Services if you believe your privacy rights have been violated by us. You may file a complaint with us by notifying our privacy officer of your complaint at our office and main telephone number. We will not retaliate against you for filing a complaint.
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This Notice was published and becomes effective on/or before .
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The name and address of the person you can contact for further information concerning our
privacy practices are:

Privacy Officer

Medegy Health Systems
7352 NW 34th Street
Miami, FL 33122
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(888) 225-0535

Accessibility Statement

Medegy Health Systems Accessibility Statement

General

Medegy Health Systems strives to ensure that its services are accessible to people with disabilities. Medegy Health Systems has invested a significant amount of resources to help ensure that its website is made easier to use and more accessible for people with disabilities, with the strong belief that every person has the right to live with dignity, equality, comfort and independence.

Accessibility on medegy.com

Medegy Health Systems makes available an accessibility tool that is powered by a dedicated server. The software allows medegy.com to improve its compliance with the Web Content Accessibility Guidelines (WCAG 2.1).

Enabling the Accessibility Menu

The medegy.com accessibility menu can be enabled by clicking the accessibility menu icon that appears on the corner of the page. After triggering the accessibility menu, please wait a moment for the accessibility menu to load in its entirety.

Disclaimer

Medegy Health Systems continues its efforts to constantly improve the accessibility of its site and services in the belief that it is our collective moral obligation to allow seamless, accessible and unhindered use also for those of us with disabilities.

Despite our efforts to make all pages and content on medegy.com fully accessible, some content may not have yet been fully adapted to the strictest accessibility standards. This may be a result of not having found or identified the most appropriate technological solution.

Here For You

If you are experiencing difficulty with any content on medegy.com or require assistance with any part of our site, please contact us and we will be happy to assist.

Contact Us

If you wish to report an accessibility issue, have any questions or need assistance, please contact Medegy Health Systems as follows:

call us at (888) 225-0535

Sitemap

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Contact Us

Contact Us

The friendly staff at Medegy Health Systems welcomes your call and looks forward to serving you. If you have any questions about our services, please call our office at (786) 441-8465 or toll-free at (888) 225-0535. You can also request a consultation now.

Our regular office hours are Monday – Friday, 9 am – 5 pm.

Location & Phone

Toll-Free: (888) 225-0535
Phone: (786) 441-8465
Fax: (305) 716-9256
Email: info@medegy.com

Address:
7300 Corporate Center Dr. STE 501
Miami, FL 33126

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Careers

Careers

At Medegy Health Systems, we are always looking for qualified and passionate professionals to join our team of dedicated providers and staff. If you enjoy working in a fast-paced environment where you can truly make a difference in the lives of our clients and their members, Medegy Health Systems is the place for you.

If you are interested in one of the opportunities below, you may submit your resume below.

Current Job Opportunities

Business Analyst, Level I

We are seeking a full-time, entry-level candidate to join our business analytics team. The department specializes in data reconciliation, data analysis, and reporting. The position plays a versatile role in supporting the finance, accounting, and claims operations departments, as well as collaborating with IT to deliver business-enhancement projects.

Responsibilities & Expectations

Primary Responsibilities

  • Reconcile, for each set of health insurance plans, patient membership data and dollar-receipts-per-member
  • Calculate monthly dollars-paid-per-member payments to physicians
  • Assist the accounting department with weekly claims payment processing
  • Audit monthly claims (to-be-paid and paid) to physicians
  • Prepare and convert monthly financial and operational data into profitability and efficiency reports for the executive team

We Expect Candidates to Be

  • Analytical and logical
  • Data-driven
  • Interested in the healthcare industry
  • Clear and concise with all forms of business communications
  • Organized in thought and the workspace

Qualifications

Required Qualifications

  • Bachelor of science in finance, accounting, or management information systems
  • Proficient in Microsoft Office Suite, especially Excel

Preferred Qualifications

  • Related work experience
  • Microsoft SQL querying
  • Report writing: Crystal Reports, PowerBI, Cognos, QlikView, Tableau, SSRS, or comparable business intelligence reporting tools

Location

Doral, Florida

Schedule

Monday – Friday, 8 am – 5 pm

Customer Support Specialist

We are seeking a full-time customer service representative to join our support services team. We are looking for a candidate who exhibits a pleasant attitude and willingness to help others. These traits are essential in assisting our customers in a friendly and respectful manner. In addition to people skills, we encourage our representatives to be goal-oriented and express a desire to learn new tools and skill sets. Ideal candidates are positive, energetic, enthusiastic, and computer-savvy.

Responsibilities & Expectations

  • Direct communication with members, providers, and health plans
  • Confirmation of benefits and eligibility information to members, providers, and health plans
  • Provide confirmation of participating providers in the network
  • Provide claim status to members, clients, and providers
  • Resolve problems by identifying the customer’s complaint, selecting and explaining the best resolution for the issue, and escalating to upper management when necessary
  • Keep managers informed of any issues that may require their attention in order to avoid or resolve an existing problem
  • Apply knowledge, experience, common sense, and critical thinking to all issues being dealt with
  • Ability to multitask and prioritize
  • Respond to general inquiries from members and providers (plan benefits, limits, co-pays, deductibles, policy procedures, reimbursements, etc.); redirect callers when necessary
  • Follow up until completion on all issues that are not resolved on the initial contact; keep parties updated on actions taken and next steps
  • Service the maximum number of callers in the quickest and most efficient way without sacrificing the quality of the service

Qualifications

Required Qualifications

  • 1+ years customer service experience in healthcare or related experience
  • High school diploma or equivalent certification
  • Excellent communication skills
  • Ability to multitask, prioritize, and manage effectively
  • Must be computer literate and able to quickly navigate in a windows PC environment
  • Must have a “can do” attitude
  • Must be organized, assertive, and patient

Preferred Qualifications

  • Experience with optometry, ophthalmology, and/or podiatry specialties
  • Bilingual (English and Spanish) preferred

Location

Doral, Florida

Schedule

Monday – Friday, 8:15 am – 5 pm

 

Medical Claims Processor

We are seeking a medical claims processor to join our team. The candidate will play an active role within claims operations to assure timely and accurate administration of claims processing, in compliance with state and federal regulations, as well as other applicable rules and requirements outlined by internal and external policies and procedures.

Responsibilities & Expectations

  • Review claims and corresponding edits to determine the appropriate handling of payments and denials
  • Review formal written appeals from providers, and send written responses of decisions within required timelines
  • Investigate claims issues by performing research and gathering information to determine the root cause of the problem
  • Communicate and collaborate with impacted departments to resolve claims issues
  • Perform other duties assigned by supervisor, and assist on requests from compliance department as needed
  • Address inquiries from providers
  • Maintain a full comprehensive understanding of claims policies and procedures by studying appropriate reference materials, including covered benefits, coding, and reimbursement policies and contracts; participate in ongoing training as needed

Qualifications

Required Qualifications

  • High school diploma, GED, or equivalent required
  • At least 3 years of healthcare administration and/or managed care experience
  • At least 3 years of claims experience that demonstrates progressive growth within claims operations
  • Strong understanding of health plan terminology
  • Computer literate and proficiency in Microsoft Office

Preferred Qualifications

  • Extensive knowledge of claims policies and procedures, including industry standards from Medicaid, CMS, and CCI Edits.

Location

Doral, Florida

Schedule

Monday – Friday, 8:15 am – 5 pm

Benefits

At Medegy Health Systems, we are a dedicated family of professionals with a strong desire to deliver quality services to our clients and their customers. We promote from within and offer internal advancement opportunities. We offer a competitive pay rate and benefits package. We provide the resources, training, and support you need to be successful and expand your career! Our associates enjoy a fun and team-oriented environment.

Benefits include:

  • Competitive pay rates and benefits
  • Paid time off program
  • Paid holidays
  • 401(k) retirement plan with company match
  • Medical and dental insurance
  • Life insurance

Apply Now

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Testimonials

Testimonials

We feel fortunate to receive reflections from our clients and their members about how Medegy Health Systems helps with their benefits administration. We are proud to share a few of these testimonials with you here:


“Humana has successfully partnered with Dr. Stern’s organizations in Florida for more than 30 years. I highly recommend his organization and his team.”

~ Stephanie Steele-Nelson, Vice President, Provider Partnerships

Humana


“Working with you has been a pleasure. Your team always comes through.”

~ Stan Silverman, Director of Transportation

EpicMD


“This group has brought great value to Coventry. The employees address matters quickly, efficiently, and thoughtfully. ”

~ Travis Butler, Director Network Management

Aetna


“Medegy is more than just a vendor. We see them as one of our most valued partners.”

~ Dannielle Dixson, Program Manager

Miami Lighthouse for the Blind


“We congratulate Medegy for consistent commitment to maintaining the highest standard possible. 99.41% clean claim rate. Wow!”

~ Matt Blandford, Client Manager

ZirMed


“We appreciate your efficiency. If only all clients were like you!”

~ Hazel Lopes, Implementation Manager

Medica


“I always enjoy working with the Medegy team due to their teamwork and professionalism.”

~ Francine Orta, Market Director, Network Operations

CarePlus


“My interactions with Medegy have always been outstanding. The assistance, cooperation, teamwork, accommodation of requests, and professionalism have always been unsurpassed.”

~ Lourdes Aguilera, Client Relationship Manager

Continucare

Find out for yourself why health plans, specialty provider networks, and managed care organizations choose Medegy Health Systems. Call us in Miami, Florida, at (786) 441-8465 or toll-free via (888) 225-0535. You can also request a consultation with us now.

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Services

Our Services

Simply put, at Medegy Health Systems, we manage your claims, increase your bottom line, and improve member satisfaction. We improve the way you do business.

We have more than 30 years of experience successfully managing fee-for-service (FFS) and capitation (CAP) contracts for commercial, Medicare, and Medicaid plans.

We offer reliable benefit administration as well as efficient and streamlined systems designed with you and your members in mind. Our fully integrated technology and expertise provides you the solutions you need, from assessing risks to managing costs. Our services run the gamut, including:

  • Account Management
  • Audit & Delegations
  • Benefit Plan Administration
  • Case Tracking
  • Claims Administration
  • Clinical Guidelines
  • Financial Management
  • HEDIS Programs
  • HIPAA EDI
  • Information Technology
  • Insight Outreach Campaigns
  • Laboratory Management
  • Member Bank Account Management

  • Payer Management
  • Premium Billing Administration
  • Reimbursement Management
  • Reporting
  • Secure Data Sharing
  • Support Services
  • Telemedicine Portal
  • Unified Communication
  • Utilization Management
  • Web Portal

The most popular of these TPA services are:

Analytics & Insights
  • Custom reporting
  • Auto report delivery
  • Centralized data mart
  • And more!
Claim Administration & Adjudication
  • Auto adjudication
  • Repricing
  • CMS guidelines
  • And more!
Compliance and Delegation
  • Claims delegations
  • Credentialing delegations
  • Corporate compliance
  • And more!
Customer Care
  • Call tracking
  • Log & track modifications
  • Comments and documentations
  • Bilingual services
  • Self-serve options
  • And more!
Membership Management
  • COB: primary and secondary
  • Auto enrollment & removal
  • ID card printing
  • And more!
Provider Credentialing & Contracting
  • Credentialing
  • Comprehensive directories
  • Multi-plan, multi-reimbursements
  • And more!

TPA Services in Miami, FL

Are you interested in learning more about our services? Call Medegy Health Systems in Miami, Florida, at (786) 441-8465 or toll-free at (888) 225-0535. You can also request a consultation now.

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Who We Serve

Who We Serve

When you contract with Medegy Health Systems, your health plan or specialty provider network gains access to a full continuum of healthcare third-party administrative (TPA) services, including network management, claims processing, credentialing, utilization management, HEDIS outreach programs, and much more.

Medegy Health Systems is an industry leader helping managed care companies administer health benefits with innovative, technology-based tools. Our clients include:

Health Plans

We provide a wide range of TPA services to our health plan clients, including automated claim adjudication, cost savings, compliance, and regular monitoring of fraud, waste, and abuse. We serve health plans such as:

  • Medicare Plans
  • Medicaid Plans
  • Commercial Plans
  • Managed Care Organizations (HMOs, PPOs, POS plans)

Specialty Provider Networks

Medegy Health Systems has crafted advanced solutions and programs aimed at simplifying and improving efficiency of administrative tasks for various specialty provider networks, including the following healthcare specialties:

  • Cardiology
  • Chiropractic
  • Dental
  • Dermatology
  • Durable Medical Equipment
  • Gastroenterology
  • General Surgery
  • Hearing
  • Hematology
  • Home Health
  • Home Infusion
  • Laboratory
  • Medical Transportation

  • Mental Health
  • Occupational Therapy
  • Oncology
  • Ophthalmology
  • Optometry
  • Orthopedics
  • Pain Management
  • Podiatry
  • Physical Therapy
  • Radiation Oncology
  • Speech Therapy
  • Urology
  • Vision

Not sure if we can help your network or managed care organization? Call Medegy Health Systems in Miami, Florida, at (786) 441-8465 or toll-free at (888) 225-0535 to find out which Medegy solution is right for your business. You can also request a consultation with us now.

 

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About Us

About Us

Medegy Health Systems is a full-service, licensed third-party administrator (TPA) working with health plans and specialty provider networks to manage more than 2 million patient lives.

As an industry-leading, premier benefits administrator, we are committed to providing our clients the very best in advanced technology, customized support, as well as targeted solutions and services.

Our proprietary managed-care software and processes add value for clients in many disciplines within the healthcare industry. It can help to streamline work within the provider network and healthcare administration process. Finally, what we do at Medegy Health Systems allows network providers to focus their time and energy on patient care – not paperwork.

Our History

1982

Our beginning (as iCare Health Options) & early successes

2001

Development of managed care software

2007

Our TPA is born

2010

Uniform communications platform designed

2012

System integration begins

2017

TPA branded as Medegy Health Systems

Our story originated in 1982 when Dr. Sidney J. Stern began his career in managed care. He founded an eye care network in South Florida that began with just 15 providers – and has grown into one of the largest, most successfully managed in the state.

In 2001, Dr. Stern developed his processes into a proprietary managed-care software platform.

As a licensed third-party administrator, Medegy Health Systems has provided proprietary managed care software and processes to its clients since 2007.

Today, we continually add value to our client businesses and across many disciplines in the healthcare industry, implementing the same quality services and success to specialty managed care provider networks throughout the country.

Values & Vision

Our core values are to develop and adopt exceedingly efficient practices and innovative technologies, so that we – and our partners – can continue to operate successfully.

Our dedicated staff adhere to the principles that set us apart: listening to our clients, learning what they need, understanding their challenges, and providing tailored solutions. We continue to integrate proven practices and advanced technology with customizable support, service, and software solutions for our clients.

With more than 30 years in the healthcare industry, our values and vision set us apart as a leader who provides excellent, innovative solutions for today’s healthcare payer.

Would you like to find out more about Medegy Health Systems? Call us in Miami, Florida, at (786) 441-8465 or toll-free at (888) 225-0535. You can also request a consultation now.

 

 

 

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Thank you

Thank You

Thank you for your interest in a career at Medegy Health Systems. If you are a qualified candidate for one of our available positions, a human resources representative will contact you.

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Medegy Health Systems offer premier TPA services for specialty provider networks and health plans.