- Apex Health Solutions (Houston, TX)
- S ummary: Position is responsible for overall strategy and effectiveness of Claims Operations. Position is responsible for oversight of claims adjudication and ... also responsible for the timely processing and accuracy of claims and day to day interactions with any vendor...Serves as point of contact in researching and presenting Claim data in all legal issues Serves as company… more
- Alight (SC)
- …vision and managing execution for Alight's Disability and Absence Management Claim Service. Accountable for defining, developing, implementing, and leading all ... aspects of Alight's STD & Absence Management claim operations. **Responsibilities** + Leading LOA, STD, ADA, and/or LTD claims service teams. It may also involve… more
- Scripps Health (San Diego, CA)
- …quarter of our employees have been with Scripps Health for over 10 years. The Director of HMO Payment ( Claims ) Services for Scripps Health Plan, leads claims ... * Mailroom experience. **Job:** **Finance* **Organization:** **Scripps Health Corp* **Title:** * Director , HMO Claims Services* **Location:** *Central San Diego… more
- Molina Healthcare (KY)
- …fee schedules, claims edits, and other system settings in the claim payment system. * Directs the development and implementation of contract and benefit ... + SQL knowledge preferred + Advanced knowledge of healthcare claims and claim processing from receipt through...to adopt and utilize work tracking software + Coding certification preferred Experience with QNXT and/or NetworX Pricer (both… more
- Elevance Health (Atlanta, GA)
- **Business Change Director - Claims /Payment Integrity Use-Case Lead** **Location:** This position will work a hybrid model (remote and office). Ideal candidates ... 50 miles of a PulsePoint location. The **Business Change Director - Claims /Payment Integrity Use-Case Lead** is responsible for...* Master's degree preferred. * Six Sigma or PMP certification is a plus For candidates working in person… more
- Humana (Columbus, OH)
- …of our caring community and help us put health first** The Medical Director actively uses their medical background, experience, and judgement to make determinations ... how to operationalize this knowledge in their daily work. The Medical Director 's work includes computer-based review of moderately complex to complex clinical… more
- GuideOne Insurance (Dallas, TX)
- As a Commercial Casualty Claims Adjuster, you will serve as a real partner to our members by processing claims accurately and efficiently so they can resume ... you. Accountabilities: + This position handles Commercial General Liability, Director 's & Officer Liability, Employment Practices Liability, Commercial Auto… more
- Brennan Center for Justice (New York, NY)
- …with recruitment, retention, and workplace culture. QUALIFICATIONS + 10- 15 years of director level experience with SPHR or CCP certification + Knowledge of ... United States, is seeking a highly skilled and experienced Director of Human Resources (HR) to support the Chief...+ Manage all employee leave plans and workers' compensation claims , including but not limited to FMLA, short-term disability,… more
- Commonwealth Care Alliance (Boston, MA)
- 011250 CCA- Claims **Position Summary:** Working under the direction of the Sr. Director , TPA Management and Claims Compliance, Healthcare Medical Claims ... to have the one or all of the required certification OR willing to get certified within 1 year...claims management, coding rules and guidelines, and evaluating/analyzing claim outcome results for accurate industry standard coding logic… more
- BronxCare Health System (Bronx, NY)
- …needed. - Participates in special projects and committees as determined by Director . Qualifications CERTIFICATION /LICENSURE : Registered Nurse or physician or a ... collection, analysis, implementation of and compliance with risk management and claims activities, support of and participation in Continuous Quality Improvement… more
- Whitney Young Health Center (Albany, NY)
- …complex or problem claims or insurance types as designated by the Director . Reviews payer coding policies and procedures to ensure that the department remains in ... and suggests solutions. Educates providers and gives feedback to Director of Revenue Cycle + Collaborates with practice managers...Certification from the AAPC as a Certified Professional Claims Coder required or obtained within 1 year from… more
- Unilever (El Segundo, CA)
- **Position Overview:** Reporting to the Director of Regulatory Affairs, the Certification Compliance Specialist will maintain the VMS Co-Op compliance systems to ... compliance with established regulatory and quality requirements with a focus on certification management. In this role you will demonstrate the behaviors of… more
- Brown University (Providence, RI)
- …policy changes for internal methods of claim reimbursement. Negotiate or approve claim settlements for claims including Internal claims from University ... University's retentions range from $25,000 to $4 million+ per claim . + Provide direction, management and leadership in the...for claims management for all aspects of claims handled by the Insurance Office. The Director… more
- CommonSpirit Health (Houston, TX)
- …risk-related subject matter expert. + Ensures that risk management activities for claims are completed including timely claim identification and reporting, ... TX office and will travel regionally in the south region. The Region Director Risk Management and Loss Prevention is responsible for orchestrating the successful… more
- University of Colorado (Denver, CO)
- **Associate Director of Risk Management, CU Denver and Anschutz Operations** **University of Colorado Denver** **Description** **Who We Are:** **Position Summary:** ... include, but are not limited to:** + Support the Director for CU Denver and CU Anschutz campus operations,...to provide services needed for Campus operations, such as claims administration, participation in claims site visits,… more
- Fairview Health Services (St. Paul, MN)
- …Hospital Billing Charging, Resolute Professional Billing Claims , Resolute Hospital Billing Claims , OR ability to obtain certification within one year of ... **Overview** The Director of Revenue Cycle provides leadership and accountability...technology that results in leading practice clean and compliant claim creation. Leads employees and influences stakeholders to follow… more
- Crawford & Company (FL)
- …by client, internal required service levels by product and profitability of assigned claim teams through maximum cost containment. The Director will help drive ... disability and absence management services for a set of claim teams, which may include one or more of...as outlined by Crawford Educational Services. + Nationally accredited certification in a related profession such as Certified Disability… more
- City of New York (New York, NY)
- …projects using complex SQL algorithms and EDW data, analyzing data to identify claims that can be reclaimed for higher federal and state reimbursement rates, ... preparing claim adjustments to maximize federal and state funding, providing...providing technical support, financial analysis, data retrieval and financial claims support to DSS and other City agencies, responsible… more
- Providence (Santa Rosa, CA)
- …specialist, project manager and patient relations staff in the dept. Manages claim activities with third party administrators (TPA) and defense attorneys. Analyzes ... on notification of event. + Reports investigative findings and manages claims with insurance carrier, third party administrator, and/or attorneys. + Prepares… more
- HCA Healthcare (Round Rock, TX)
- …HCA Healthcare colleagues invested over 156,000 hours impacting our communities. As a(an) Director of Patient Safety with St. David's Round Rock Medical Center, you ... preferred banking partnerships + Education assistance (tuition, student loan, certification support, dependent scholarships) + Colleague recognition program + Time… more