- Molina Healthcare (Chandler, AZ)
- …Department of Health and Human Services (DSHS) and Medicare billing guidelines, Molina claims processing policies and procedures, and other resources to validate ... application. Follows department processing policies and procedures including, claims processing (claim reversals and adjustments), claim recovery (refund… more
- Commonwealth Care Alliance (Boston, MA)
- …in Healthcare Revenue Integrity, Payment Integrity, and Analytics 5+ years of Facets Claims Processing System Required Knowledge, Skills & Abilities (must have): ... (CPT, HCPCS, Modifiers) along with the application of Medicare/Massachusetts Medicaid claims ' processing policies, coding principals and payment methodologies… more
- Commonwealth Care Alliance (Boston, MA)
- …certifications Required Experience (must have): 3+ years in healthcare claims processing , provider reimbursement, or payment integrity. Experience ... 011250 CCA- Claims This position is available to remote employees...at this time. Position Summary: Reporting to the Director, Claims Operations and Quality Assurance, the Claims … more
- CVS Health (Oklahoma City, OK)
- …Reviews pre-specified claims or claims that exceed specialist adjudication authority or processing expertise. Applies medical necessity guidelines, ... is a fulltime teleworker opportunity in Oklahoma. The Senior Claim Data Specialist handles end-to-end processes associated with claim data management. This person… more
- Robert Half (Minnetonka, MN)
- …and identify discrepancies. Utilize Epic Clinical systems and other tools to manage claims processing workflows. Maintain detailed and organized records of ... Description We are looking for a detail-oriented Denials Specialist to join our team in Minnetonka, Minnesota... resolution. Proficiency in Epic Clinical systems and other claims processing software. Strong skills in numeric… more
- Sedgwick (Harrisburg, PA)
- …techniques including strategic vendor partnerships to reduce overall cost of claims for our clients. Communicates claim action/ processing with appropriate ... to Work Fortune Best Workplaces in Financial Services & Insurance Unemployment Specialist PRIMARY PURPOSE : To analyze complex or technically difficult unemployment … more
- Beth Israel Lahey Health (Charlestown, MA)
- …and resubmits claims through the Epic billing system Handles Paper claims processing including proper documentation of accounts with higher level of ... oversight of the Department Manager & Supervisor, the Patient Financial Services Specialist - Hospital Billing will be responsible for efficient & timely billing… more
- Molina Healthcare (Phoenix, AZ)
- …communicate written and verbal Knowledge of verifying documentation related to updates/changes within claims processing system . Experience using claims ... incorrect coding, abuse and fraudulent billing practices, waste, overpayments, and processing errors of claims . ( Use for claims specific positions only )… more
- Trinity Health (Livonia, MI)
- …Monday-Friday 8:30 am-5pm No Weekends w/Holiday Rotations Position Purpose: The Authorization Specialist is responsible and accountable for the processing of all ... defined by policy. Interfaces with THAH to resolve problems related to the processing of bills/ claims . Investigates client accounts and provides any additional… more
- Molina Healthcare (Akron, OH)
- …information concisely, accurately and in accordance with regulatory requirements. Researches claims processing guidelines, provider contracts, fee schedules and ... environment, or equivalent combination of relevant education and experience. Health claims processing experience, including coordination of benefits (COB),… more
- Sedgwick (Little Rock, AR)
- …college or university preferred. Experience Four (4) years of experience in claims processing or related business experience, or equivalent combination of ... Workplaces in Financial Services & Insurance Remote Customer Service Specialist - Remote SCHEDULE: Sun/Mon/Tues/Wed/Fri 9:30am-6:30pm EST PRIMARY PURPOSE: To provide… more
- Oracle (Salem, OR)
- …guidelines. Regulatory Compliance : Stay current with regulatory requirements related to claims processing across payers and government entities such as ... this exciting arena. We are looking for a Senior Claims Denial Prevention and Appeals Specialist for providing clinical inputs to engineering for developing the… more
- BroadPath Healthcare Solutions (Tucson, AZ)
- …of foundational Utilization Management experience General understanding of health plan operations, claims and eligibility systems, claims processing , and ... Appeals and Grievance Specialists . The Appeals and Grievance Specialist plays a key role in helping members navigate...Texas Department of State Health Services Background in benefits, claims processing , or membership Diversity Statement At… more
- Molina Healthcare (Grand Rapids, MI)
- …information concisely and accurately, in accordance with regulatory requirements. Research claims processing guidelines, provider contracts, fee schedules and ... E: Min. 2 years operational managed care experience (call center, appeals or claims environment). Health claims processing background, including coordination… more
- Community Health Systems (Kingston, PA)
- …and standards. Qualifications 0-2 years of experience in medical billing, insurance claims processing , or revenue cycle management required Knowledge, Skills and ... Billing Specialist I is responsible for performing insurance claim processing , billing, and follow-up to ensure timely and accurate reimbursement. This position… more
- Otsuka America Pharmaceutical Inc. (Lancaster, PA)
- …everyday health. In its evolved customer engagement model, a Neuroscience Specialist engages healthcare providers (HCPs) using in-person, virtual, and digital tools, ... patient care and provide a superior experience. The Neuroscience Specialist will report directly to the respective Area Business...offered money for equipment fees or some other application processing fee, even if claimed you will be reimbursed,… more
- Cognizant (St. Paul, MN)
- …policies. Basic qualifications: 2 years of Appeals and Grievance 1 Year of medical claims processing experience (Must be with a healthcare plan, not on behalf ... Provider Appeals & Grievances Specialist (remote) This is a remote position open...provider's office) Medicaid & Medicare insurance customer service or claims processing 2 Years of medical health… more
- Select Medical (Camp Hill, PA)
- …accurate in terms of payer contracts, insurance processes, coordination of benefits, claims processing and state and federal statutes regarding overpayment ... Overview Credit Balance Specialist ON-SITE ($18.50/h Starting) Camp Hill, PA Monday...accounting, collections and high volume medical billing and/or insurance claims processing experience preferred. Strong interpersonal, oral… more
- Globus Medical, Inc. (Collegeville, PA)
- …detailed claims review, and hotline support. The Patient Access Specialist will be responsible for providing payer coverage expertise and support regarding ... Position Summary : Reporting to the Supervisor, Patient Access, the Patient Access Specialist will focus on providing payer coverage support to customers from the… more
- Fifth Third Bank, NA (Cincinnati, OH)
- …reports from escrow vendors to ensure the timely completion of payment processing for monthly transactions, monitored by FDICIA & Sarbanes Oxley. Prepare wires ... and Bancorp requirements. Review, approve or deny & pay claims for tax provider that result in 5/3 charge...& affiliates on customer services issues relating to escrow processing ; make appropriate account adjustments to correct improper escrow… more
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