- CareFirst (Baltimore, MD)
- **Resp & Qualifications** **PURPOSE:** The Risk Adjustment Coding Specialist supports prospective risk adjustment via concurrent review and supplemental data ... CMS filing, HHS-Risk Adjustment Data Validation (RADV) audit and any other chart...Verifies accuracy, completeness, and appropriateness of diagnosis codes with provider partnerships based on medical documentation provided at all… more
- Centene Corporation (Phoenix, AZ)
- …field required: 3+ years equivalent experience in Health Insurance, Customer Service, Claims , or Provider Office required: Knowledge of healthcare, managed care, ... home. Candidate must live in Arizona. **Position Purpose:** Utilize risk adjustment methodologies, principles, and knowledge of managed care organizations to… more
- UCLA Health (Los Angeles, CA)
- Description As the Clinical Documentation Integrity Specialist - Medicare Advantage Risk Adjustment , you will be an expert in risk adjustment coding and ... Coding Specialist (CCS) certification, required + A Certified Risk Adjustment Coder (CRC), required + Registered Nurse (RN) or clinical qualifications a… more
- AON (MA)
- Commercial Property Claims Specialist This position is responsible for managing Property Claims Management Program for a client of Aon. The position is ... conditions of the applicable incentive plan. #LI-MB1 #LI-REMOTE 2545848 Commercial Property Claims Specialist This position is responsible for managing Property … more
- Zurich NA (Addison, TX)
- General Liability Claims Specialist I 112465 At Zurich North America Claims we acknowledge that work life-balance and flexibility are a priority when it ... our General Liability team. As a General Liability (GL) Claims Specialist , you will work with a...develop and maintain strong relationships. + Understanding of the claims adjustment process and ability to determine… more
- City of New York (New York, NY)
- …identify, and report fraudulent claims , utilize statistical data to identify claims that pose potential risks, and provide risk management recommendations to ... employees serving in a permanent (not provisional) Civil Service title of Claim Specialist . To be considered for this position, PLEASE CLEARLY INDICATE YOUR CURRENT… more
- Magellan Health Services (Maryland Heights, MO)
- …to be required, acting within established parameters, this role makes the appropriate payment adjustment into the claims system. Must complete duties with a high ... abandonment rate, talk time). Comfortable adapting to change. General Job Information Title Claims Resolution Specialist Grade 20 Work Experience - Required … more
- Louisiana Department of State Civil Service (Baton Rouge, LA)
- …Differs from State Risk Adjuster 5 by responsibility for managing a section of claims adjustment units rather than a single unit within a section, and ... ) by the absence of full authority for the claims adjustment division, and by unlimited ...your proficiency in preparing detailed reports and spreadsheets that provide claims data for analysis. Provide… more
- Fairview Health Services (St. Paul, MN)
- …encounters and how physician documentation translates into ICD-10-CM and HCC risk adjustment for claims submission to meet reporting requirements. + Ensures ... Certified Professional Coder - Hospital (CPC-H), Certified Clinical Documentation Specialist -Outpatient (CCDS-O), Certified Risk Adjustment Coder (CRC)… more
- Priority Health Care (Marrero, LA)
- …claim inquiries. + Communicates with insurance companies for status on outstanding claims . Credentialing: Provide backup support for Revenue Cycle: + Credential ... JOB SUMMARY: The Revenue Cycle Specialist II must adhere to the Code of...business licenses, renewals, liability policies, and payer contracts. + Provide weekly statuses of provider progress to… more
- Veterans Benefits Administration (Indianapolis, IN)
- Summary As a Program Specialist you will serves as the quality review and training coordinator for the division. Responsible for analyzing data associated with ... announcement, 11/21/2024. Specialized Experience for GS-11: To qualify for the Program Specialist , GS-0301-11 position, you must have at least one year (52 weeks)… more
- Motion Recruitment Partners (Alpharetta, GA)
- …Center Support) Alpharetta, GA **Hybrid** Contract $15/hr - $16.67/hr Exciting Provider Concierge Specialist opportunity with an established firm. **Contract ... experience working in a large dental or medical plan, provider relations, and operations ( claims & customer...Knowledge of the company's claims processing systems claims flows and adjustment notices. **Education:** +… more
- MAPFRE Insurance (Webster, MA)
- Claim Specialist , Casualty (Hybrid) Date: Nov 15, 2024 Location: Webster, MA, US Company: MAPFRE Bring your passion and enthusiasm for Claims to our TEAM! At ... moderate and high severity Bodily Injury and Un/Under Insured Motorist claims . This position requires proficiency in interpreting Personal and Commercial Auto… more
- Dialysis Clinic, Inc. (Nashville, TN)
- …during every patient interaction. We seek motivated, compassionate individuals to provide top-notch patient care and offer paid training, competitive pay, ... with a lower caregiver-to-patient ratio than other providers. **The Billing Specialist ** must have effective communications skills. This position requires a large… more
- BrightSpring Health Services (Englewood, CO)
- Our Company Amerita Overview Amerita is a leading provider of Specialty Infusion services focused on providing complex pharmaceutical products and clinical services ... Providing service to all the Amerita locations, the PBM Payer Audit Specialist reviews audit request, compiles and classifies existing documentation and identifies… more
- Dialysis Clinic, Inc. (Spartanburg, SC)
- …1971, Dialysis Clinic, Inc. (DCI) remains the nation's largest non-profit dialysis provider . With a team of approximately 5,000 talented and caring employees serving ... dialysis providers for the past 13 years in a row. **The Billing Specialist ** must have effective communications skills. This position requires a large degree of… more
- Veterans Benefits Administration (Columbia, SC)
- …payments, resume payments change of name notice, change of fiduciary notice and all adjustment actions on VRE claims as required. Process applications for VRE, ... rights and benefits, the submission of evidence, disposition of claims , reasons for our decisions, evidence considered and all...such as 18, 30, 33, 35, 36, and 1606. Provide due process, as necessary. Assists in the effective… more
- Aston Carter (Tampa, FL)
- Job Title: Immediate Supply Chain Specialist Job Description The Supply Chain Specialist is responsible for providing exceptional customer support to both ... objectives and tactical plans aimed at corporate business growth. The specialist will proactively address service issues and customer concerns, ensuring timely… more
- Rush Enterprises (San Antonio, TX)
- The Sales Specialist is responsible for providing direct support to Sales Representatives, and Customers/Policy holders with new and/or renewal accounts. Rush Truck ... RTIS is a subsidiary of Rush Enterprises, who is a multibillion-dollar solutions provider to the commercial vehicle industry with the largest network of commercial… more
- Robert Half Office Team (Helena, MT)
- …to gather and analyze data related to HEDIS measures. + Conducts claims research, determining correct service location and/or verifying member history + Performs ... provider outreach, verifying and confirming provider demographics...database tools + Performs medical record reviews for risk adjustment , HEDIS(R) and HEDIS(R)-like measures via remote EMR access… more