- Guidehouse (Gardena, CA)
- …may contact Chris Rivera (Manager, Talent Acquisition) at ###_** **Essential Job Functions** + Medicare Claims + Account Review + Appeals & Denials + Medicare ... **What You Will Do** **:** The **Insurance Patient Account Representative - Medicare Emphasis** is an extension...denials. **What Would Be Nice To Have** **:** + Medicare claims emphasis + PC skills in… more
- State of Indiana (Indianapolis, IN)
- Medicare Claims Analyst Date Posted: Jun 6, 2024 Requisition ID: 443202 Location: Indianapolis, IN, US, 46204 Work for Indiana Begin a fulfilling career with the ... accessible, and equitable workplace with a workforce that is representative of Indiana's population. As a proud equal opportunity...is fully engaged with this mission. Role Overview: The Medicare Claims Analyst will serve as the… more
- Regional Transit Service (Rochester, NY)
- Senior Claims Representative - Workers' Compensation / Automobile Apply Now! Back to search Location: Rochester, NY Posted: 06/19/2024 Location Name: RTS Monroe ... Second Injury Fund excess recoveries and Social Security and Medicare offsets. + Reports claims to the...& WORK ENVIRONMENT: The physical demands described here are representative of those that must be met by an… more
- Sedgwick (Charlotte, NC)
- …work. Great Place to Work(R) Most Loved Workplace(R) Forbes Best-in-State Employer Claims Representative - Workers Compensation **PRIMARY PURPOSE** : To process ... or equivalent combination of education and experience or successful completion of Claims Representative training required. **Skills & Knowledge** + Developing… more
- Sedgwick (Sun Prairie, WI)
- …to work. Great Place to Work(R) Most Loved Workplace(R) Forbes Best-in-State Employer Claims Representative - Liability **PRIMARY PURPOSE** **:** To process low ... level general liability claims to determine benefits due; to ensure ongoing adjudication...disability duration, medical management practices and Social Security and Medicare application procedure as applicable to line of business… more
- HCA Healthcare (Denver, CO)
- …want to join an organization that invests in you as a Medical Insurance Claims Representative ? At HCA Healthcare, you come first. HCA Healthcare has committed ... difference. We are looking for a dedicated Medical Insurance Claims Representative like you to be a...and administer contracts in collection of third party accounts ( Medicare and Medicaid) + You will complete account reconciliation… more
- TEKsystems (Minneapolis, MN)
- …eligibility, ID cards, clinic changes, demographic changes, benefit coverage, claims , payments, member reimbursement, and demonstrated knowledge of CAG policies, ... center, Health care, Data entry, Insurance, Member service, Health plan, medicare Top Skills Details: Customer service call center,Support,Css,Cms Additional Skills… more
- BrightSpring Health Services (Arlington, TX)
- …information, completing necessary documentation, and following up on outstanding claims . + Understands Insurance and Medicaid formularies and processes, including ... regarding prior authorization concerns + Achieves productivity goals with regard to calls/ claims per hour, as determined by the Director and Clinical Hub Manager.… more
- Molina Healthcare (Nicholasville, KY)
- …pharmacy prior authorization requests and/or appeals. + Explains Point of Sale claims adjudication, state, NCQA, and CMS policy/guidelines, and any other necessary ... information to providers, members, and pharmacies. + Assists with clerical services/tasks and other day-to-day operations as delegated. + Effectively communicates plan benefit information, including but not limited to, formulary information, copay amounts,… more
- Centers Plan for Healthy Living (Staten Island, NY)
- Claims Service Representative 75 Vanderbilt Ave, Staten Island, NY 10304, USA Req #811 Monday, July 1, 2024 Centers Plan for Healthy Living's goal is to create ... Plan for Healthy Living (CPHL), is a Managed Care Organization servicing members with Medicare and/or Medicaid. Our goal is to provide members and all those involved… more
- Trinity Health (Farmington Hills, MI)
- …or other health care financial service setting, performing medical claims processing, financial counseling, financial clearance, accounting, or customer service ... insurance and governmental programs, regulations, and billing processes, eg, Medicare , Medicaid, Social Security Disability, Champus, Supplemental Security Income… more
- Highmark Health (Annapolis, MD)
- …models. This job is a highly skilled subject matter expert (SME) in Medicare STARS, Medicaid HEDIS and risk revenue streams and provides strategic, hands-on, office ... based support to PCPs for analysis of performance Medicare STARS, Medicaid HEDIS and risk revenue streams, identifies opportunities for improvement in value… more
- Specialty Rx, Inc. (Ridgefield Park, NJ)
- Job Description SpecialtyRx is a full-service pharmacy. We need Medicare Part B- Billing Representative with Pharmacy experience in our Ridgefield Park, NJ ... benefits package. Responsibilities: + Experience with billing Part B claims , review and handle denials. + Knowledge with vaccine...Knowledge with vaccine billing, including Covid. + Must research claims and denial codes. + Must correctly resubmit … more
- Access Dubuque (Dubuque, IA)
- …not limited to: subrogation, Second Injury Fund excess recoveries and Social Security and Medicare offsets. + Reports claims to the excess carrier; responds to ... Claims Examiner - Liability **Sedgwick** 1 Positions ID:...principles including medical management practices and Social Security and Medicare application procedures as applicable to line-of-business. + Excellent… more
- Access Dubuque (Dubuque, IA)
- Claims Adjuster - Liability **Sedgwick** 1 Positions ID: R49657 Posted On 07/03/2024 **Job Overview** Taking care of people is at the heart of everything we do, and ... work. Great Place to Work(R) Most Loved Workplace(R) Forbes Best-in-State Employer Claims Adjuster - Liability **PRIMARY PURPOSE:** To analyze mid- and higher-level… more
- Insight Global (Los Angeles, CA)
- …Insurance Plan based in Los Angeles is in the immediate need of a Medical Claims Representative . The Medical Claims Representative will be responsible ... phone and troubleshooting any of the participants bills or claims . The Medical Claims Representative ...- Extensive knowledge of Plan benefits, group insurance, and Medicare principals. - Knowledge of Coordination of Benefits rules.… more
- Access Dubuque (Dubuque, IA)
- Claims Examiner - Auto Liability **Sedgwick** 1 Positions ID: R51674 Posted On 07/02/2024 **Job Overview** Taking care of people is at the heart of everything we do, ... to work. Great Place to Work(R) Most Loved Workplace(R) Forbes Best-in-State Employer Claims Examiner - Auto Liability **PRIMARY PURPOSE** : To analyze and process… more
- Centers Plan for Healthy Living (Staten Island, NY)
- Claims Auditor 75 Vanderbilt Ave, Staten Island, NY 10304, USA Req #1153 Monday, July 1, 2024 Centers Plan for Healthy Living's goal is to create the ultimate ... Responsible for the auditing functions of Centers Plan for Healthy Living (CPHL) claims . Collaborates with other Health plan departments and Management to ensure … more
- Travelers Insurance Company (Indianapolis, IN)
- …**What Is the Opportunity?** Under general supervision, manage Workers' Compensation claims with lost time to conclusion and negotiate settlements where appropriate ... to resolve claims . Coordinate medical and indemnity position of the claim...losses involving issues of statutory benefit entitlement, medical diagnoses, Medicare Set Aside to achieve resolution through the best… more
- Travelers Insurance Company (Buffalo, NY)
- …**Target Openings** 1 **What Is the Opportunity?** Manage Workers' Compensation claims with lost time to conclusion and negotiate settlements where appropriate ... to resolve claims . Coordinate medical and indemnity position of the claim...losses involving issues of statutory benefit entitlement, medical diagnoses, Medicare Set Aside to achieve resolution through the best… more