- Commonwealth Care Alliance (Boston, MA)
- …Summary:** Working under the direction of the Sr. Director, TPA Management and Claims Compliance, Healthcare Medical Claims Coding Sr. Analyst will be ... responsible for developing prospective claims auditing and clinical coding and reimbursement edits and...the request based on business needs and requirements, provider resolution option based on financial ability and forecasting for… more
- Sedgwick (Columbus, OH)
- …management, executive, cyber, public entity, errors and omissions, and professional liability claims ; to provide resolution of said type of highly complex ... relationships. + Ensures claim files are properly documented and claims coding is correct . + Refers cases...(CPCU), Associate in Risk Management (ARM), Associate in Insurance Claims (AIC), Certified Professional in Health Care… more
- CenterLight Health System (Flushing, NY)
- …for provider education and/or system (re)configuration. Initiates and follows through with resolution of all pended claims , (re)pricing, returned or refund ... JOB PURPOSE: The Claims Specialist will support department operations related to...trends to determine root causes. Proposes workflow changes to correct and enhance claim processes to prevent returned checks/refunds… more
- Walmart (Orlando, FL)
- …return messages, reject codes, and insurance problem descriptions; reprocessing third-party claims using the correct procedures to resolve issues; rescanning ... Position Summary What you'll do We are hiring Certified Pharmacy Technicians for our Orlando, Florida location. The candidate must meet state requirements to work as… more
- University of Rochester (Rochester, NY)
- …a payment date from the payer. + Research and calculate underpaid or overpaid claims ; determine final resolution . + Re-calculate claim based on fee schedule, APC ... add-ons + Follow up with payers on incorrectly paid claims through final resolution and adjudication, including...correct full reimbursement + Billing primary and secondary claims to insurance + Review paper claims … more
- Central Maine Medical Center (Lewiston, ME)
- …of actions taken on the account 8. resolving the account (posting correct contractual adjustments, posting other non-cash related Explanation of Benefits (EOB) ... information, updating the patient accounts as appropriate 9. submitting uncollectible claims for adjustment timely and correctly 10. resolving claims impacted by… more
- UPMC (Pittsburgh, PA)
- …and resource utilization. This includes using vast clinical knowledge to ensure correct DRG procedural and diagnosis codes have been used appropriately on ... claims . This role also acts as a SME for..., and Medical Directors as needed to facilitate the resolution of issue or cases. Responsibilities may involve multiple… more
- University of Rochester (Rochester, NY)
- …such as demographics, insurance company, diagnosis, modifiers, etc. Determines correct method of resolving discrepancies by utilizing internal and external ... and location. Correctly identifies diagnosis codes and charges are appropriate for claims to be effectively released and submitted to the assigned insurance… more
- Arab Community Center for Economic and Social Serv (Dearborn, MI)
- …Medical Billing and Coding Specialist is responsible for processing health insurance claims for services provided at all clinics. Employee is responsible for ... submitting claims for reimbursement and coach healthcare providers to achieve...with external organizations that allow for streamlining and quick resolution of billing matters for patients + Document conversations… more
- Trinity Health (Chelsea, MI)
- …for the purpose of establishing the patient and service specific record for claims processing and maintenance of an accurate electronic medical record. Registers and ... information system(s), to ensure accurate and timely submission of claims . Determines visit-specific co-payments and collects out-of-pocket liabilities. Assists… more
- Central Maine Medical Center (Lewiston, ME)
- …and accuracy of Patient Financial Services processes (such as claims processing, payment variances, payment posting, accounts receivable management, financial ... is specifically responsible for any of the following: + Claims Processing + Claims Edit Management (DNFB)...Payer Analytics + Accounts Receivable Management + Payment Variance Resolution , including Patient and Payer Credits + Patient Follow… more
- Aston Carter (Torrance, CA)
- …Title: Warranty AdminJob Description The Warranty Admin will be responsible for claims analysis and processing, supporting warranty claims administration, and ... collaboratively with various teams and departments. Responsibilities + Support warranty claims administration, including labor operation coding and flat rate time… more
- Trinity Health (Chelsea, MI)
- …for the purpose of establishing the patient and service specific record for claims processing and maintenance of an accurate electronic medical record. Registers and ... information system(s), to ensure accurate and timely submission of claims . Determines visit-specific co-payments and collects out-of-pocket liabilities. Assists… more
- Southwire (Carrollton, GA)
- …control by using tools and technologies such as cameras and poka-yoke to inhibit, correct , or highlight when an error occurs. * Works with plant operations to lead ... * Assists in driving progress toward prompt Supplier Claim resolution , makes claim presentations to Suppliers as needed (plant...to Suppliers as needed (plant specific), and evaluates customer claims pertaining to the Plant and works toward timely… more
- The Cigna Group (Seattle, WA)
- …of guidance, this position performs complex on-site network pharmacy audits to correct risks identified, protect client assets, and present findings to key internal ... requirements. **ESSENTIAL FUNCTIONS** + Perform efficient and effective network pharmacy claims audits to produce results consistent with departmental policies and… more
- Houston Methodist (Houston, TX)
- …for resolving all outstanding third party primary and secondary insurance claims for professional services. This position performs collections activities on simple ... and Account Managers to communicate and prevent denials. Provides suggestions for resolution . + Assists with knowledge sharing, payor and department cross training,… more
- Dart (Des Moines, IA)
- … as well as work with DART legal counsel and insurance companies for resolution of the claims . + Move to recommended training/certification requirements Serves ... three months, a Commercial Driver's License. + Certifications preferred such as: + Certified Safety Professional (CSP) + Certified Emergency Manager (CEM) +… more
- The County of Los Angeles (Los Angeles, CA)
- …and reports performance issues to a higher-level technologist or supervisor for resolution ; records results of the preventive maintenance in maintenance log. + ... Sleep Technologist (RST) by the American Board of Sleep Medicine + Certified Pulmonary Function Technologist (CPFT) by the National Board for Respiratory Care… more
- The County of Los Angeles (Los Angeles, CA)
- …with other systems and County departments. Coordinates the identification and resolution of complex problems, and recommends improvements and modifications in line ... monitoring projects, determining systems and procedures for performance metrics. + Certified in Project Management Professional (PMP) from the Project Management… more
- The County of Los Angeles (Los Angeles, CA)
- …large size by controlling all aspects of cost and schedule, and through resolution of issues that pertain to successful project delivery; Coordinates the input and ... A valid certification by the Construction Management Association of America as a certified construction manager is required. Applicants MUST attach a copy of valid… more