- Humana (Annapolis, MD)
- …level by driving real impact and shaping the future of claims management? As a Senior Pharmacy Claims Professional , you will play a pivotal role in ... and take the lead on building solutions that make a difference! The Senior Pharmacy Claims Professional analyzes and answers inquiries regarding… more
- Humana (Washington, DC)
- **Become a part of our caring community and help us put health first** The Senior Pharmacy Claims Professional adjudicates pharmacy claims and ... process pharmacy claims for payment. The Senior Pharmacy Claims Professional work assignments involve moderately complex to complex issues where… more
- Elevance Health (Washington, DC)
- **Account Service Manager Sr - Pharmacy Account Management** **Location:** This position will work a hybrid model (remote and office). The ideal candidate must live ... plan design, researching and resolving phone and written inquiries, resolving claims , benefit and enrollment issues. + Presents monthly, ad hoc, mid-year,… more
- Elevance Health (Hanover, MD)
- …referral, and use of proprietary data and claim systems for review of facility, professional and pharmacy claims . + Responsible for independently identifying ... **Investigator Senior ** **Supports the Payment Integrity line of business**...to recover corporate and client funds paid on fraudulent claims . **How will you make an impact:** + Claim… more
- Humana (Washington, DC)
- …informaticists to define various clinical concepts and extract clinical information from medical, pharmacy , and lab claims for analytics and modeling purposes + ... + Healthcare or managed care working experience + Experience working with medical, pharmacy , lab claims + Experience working with big data and using… more
- CareFirst (Baltimore, MD)
- …risk score methodology, risk score calculation, ACA enrollment, premiums, medical and pharmacy claims , and provider data. Incumbent is responsible for performing ... **Resp & Qualifications** **PURPOSE:** The Senior Risk Adjustment Analyst assumes a pro-active approach...as required. **Note:** We are looking for an experienced professional in the greater Baltimore/Washington metropolitan area who is… more
- VHC Health (Arlington, VA)
- Senior Epic Resolute Hospital Billing Analyst II Job Description Purpose & Scope: This position is responsible for leading, coordinating, and supporting the ... of the Epic hospital billing module installation. Responsibilities include serving as the senior point of contact with clinical areas that are the primary users of… more
- Deloitte (Washington, DC)
- Life Sciences Market Access Senior Manager An evolving customer and regulatory landscape, mounting pipeline of next-gen assets and portfolio pressures, and ... + Lead team in development of quantitative and/or qualitative analysis (eg, claims data analysis, market research data) to drive meaningful insights for our… more
- Elevance Health (Hanover, MD)
- …referral, and use of proprietary data and claim systems for review of facility, professional and pharmacy claims . + Responsible for identifying and ... healthcare fraud in order to recover corporate and client funds paid on fraudulent claims . **How you will make an impact:** + Claim reviews for appropriate coding,… more
- CenterWell (Silver Spring, MD)
- …team at the branch to ensure other billing requirements are satisfied to release claims timely. + Adhere to and participate in Agency's mandatory HIPAA / Privacy ... Guidelines. + Managing all incoming telephone calls in a professional manner including: + Screen and route calls to...at the center. As the nation's largest provider of senior -focused primary care, one of the largest providers of… more