- St. Luke's University Health Network (Allentown, PA)
- …The RN Clinical Review Appeals Specialist retrospectively reviews patient medical records, claims data and coding of all diagnosis and procedure codes to ... determination made by the government or commercial payors, or their auditor representative . + Facilitate clinical chart reviews to assist with supporting assigned… more
- Ochsner Health (New Orleans, LA)
- …make a difference at Ochsner Health and discover your future today!** The Appeals Specialist is responsible for managing and resolving insurance claim denials and ... + Must have computer skills and dexterity required for data entry and retrieval of patient information. Must be...**Job Duties** + Review and analyze denied or underpaid claims to determine appeal opportunities. + Prepare and submit… more
- Mendocino County Sheriff's Office (Ukiah, CA)
- …Must obtain accreditation by the California Department of Veterans Affairs as a Claims Representative in accordance with Title 38 Code of Federal Regulations ... such as military, medical, and legal records. + Prepares, submits, and monitors claims and appeals through appropriate federal, state, and local channels,… more
- UNC Health Care (Chapel Hill, NC)
- …philosophy. Job Responsibilities: + Responsible for the accurate and timely submission of claims follow up, reconsideration and appeals , response to denials, and ... payer, system or escalated account issues. + May maintain data tables for systems that support PB Claims... data tables for systems that support PB Claims operations. + Evaluate carrier and departmental information and… more
- Banner Health (Tucson, AZ)
- …settings by including remote and hybrid opportunities. As a **Provider Experience Representative ** for Banner Plans & Networks you will take inbound calls answering ... will call upon your **background in medical billing, medical claims , customer service, and managed care** to answer complex...goal of first call resolution. As a **Provider Experience Representative ** , you will be working in a hybrid/remote… more
- Owens & Minor (Springfield, IL)
- … representative follows-up with insurance companies to resolve unpaid claims . **ESSENTIAL DUTIES AND RESPONSIBILITIES** + Researches any overdue account balance ... customers on delinquent payments. + Reviews unpaid and underpaid claims . Resubmits or appeals as necessary. +...a strong ability to understand, interpret and develop spreadsheet data . **Other Skills** **PHYSICAL DEMANDS** This is a stationary… more
- Aston Carter (Nashville, TN)
- … data entry, customer support, inbound call handling, insurance, insurance claims , property and casualty, claim processing, appeals , and insurance billing. ... Job Title: Customer Service Representative 3Job Description The role of a Customer... 3Job Description The role of a Customer Service Representative 3 is to interact with customers by providing… more
- State of Massachusetts (Boston, MA)
- …work, available for work and looking for a job. The Job Service Representative I performs customer service and issue resolution by assisting employers or claimants ... determinations in accordance with MGL Chapter 151A, 430 CMR, the Job Service Representative 's Handbook, and established Revenue Procedures as well as the Code of… more
- University of Rochester (Rochester, NY)
- …the individual, and internal equity considerations._ **Responsibilities:** GENERAL PURPOSE The claims resolution representative II is responsible for working ... include but are not limited to researching, correcting, resubmitting claims , submitting appeals and taking timely and...and taking timely and routine action to resolve unpaid claims . The Claims Resolution Representative … more
- University of Rochester (Albany, NY)
- …expertise of the individual, and internal equity considerations._ **Responsibilities:** The Claims Resolution Representative III is responsible for working ... process taking timely and routine action to resolve unpaid claims . The Claims Resolution Representative ...with appropriate departments to generate a detailed rational for appeals and grievances to the insurance companies. + 10%… more
- State of Colorado (CO)
- …for managing business process improvement in a professional setting for a large data , claims and integration system. 09 List any additional relevant experience ... for Colorado Medicaid Enterprise System (CMES) system and interface design, data integration, API design and testing supporting HR1 Medicaid Work Requirements… more
- State of Colorado (Denver, CO)
- …dose cassettes). + Issues credits back to clients. + Process Medicare Part D claims . + Completes associated paperwork and computer data entry. Package and Fill ... of inventory for (near) outdated medication for removal and replacement, data entry, ordering and restocking pharmaceuticals and supplies, pre-packaging and labeling… more
- Hart Medical Equipment (Grand Blanc, MI)
- …and verification of benefit when required. + Preparing, reviewing, and transmitting claims using billing software, including electronic and paper claim processing. + ... Following up on unpaid claims within standard billing cycle timeframe. + Checking each...employees regarding assigned accounts, the billing process or the appeals process . This includes reviewing for accuracy, completeness,… more
- Amentum (Washington, DC)
- …Fund ("VCF") was created to provide compensation for any individual or personal representative of a deceased individual who suffered physical harm or was killed as ... claim review team work, with a particular emphasis on claim and data management, claim assessment, knowledge management and training coordination. Working closely… more
- PeaceHealth (Vancouver, WA)
- …Responsible for all areas of billing and account follow-up including claims submission, account follow-up with insurance payors, and resolution of reimbursement ... **Essential Functions** + Resolves insurance claim rejections/denials, and non-payment of claims by payors. + Identifies trends in billing and follow-up, in… more
- Blue Cross and Blue Shield of Minnesota (Eagan, MN)
- … data across multiple domains, including utilization management, prior authorization, claims , denials, and appeals . Their work goes beyond extraction; it ... with internal teams such as Network and Pharmacy, ensuring data is pulled using the most representative ...degree. * Knowledge of managed care and health care claims preferred. * Experience with Databricks preferred. Compensation and… more
- Iowa Department of Administrative Services (Cedar Rapids, IA)
- …contact work obtaining, analyzing and evaluating data such as job/ claims interviewing, testing, referral and/or placement, sales representative , credit ... contact work obtaining, analyzing and evaluating data such as job/ claims interviewing, testing, referral and/or placement, sales representative , credit… more
- Highmark Health (Montpelier, VT)
- …of benefit billing practices through paid clams review. + Participate as pharmacy representative in onsite member appeals and grievances sessions. + Serve as ... medication requests, and drug claim edits/prior authorizations. By reviewing member claims history, clearly defines the medical necessity of non-formulary and prior… more
- CVS Health (Trenton, NJ)
- …team, and measuring success through improved member health as evidenced through Data Analytics. + Assists the customer's Wellness Representative (s) in managing ... navigating them through the health system, providing support on claims issues, and answering coverage-level questions. **We have two...the employees and the customer Total Rewards team on appeals . + Assist the Total Rewards team with the… more
- Blue Cross and Blue Shield of Minnesota (Eagan, MN)
- …responsible for answering customer questions pertaining to product information, benefits, claims resolution and eligibility in a call center environment. This ... Responsible for answering customer questions pertaining to product information, benefits, claims resolution and eligibility in a call center environment. * Conducts… more
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