- Humana (Columbus, OH)
- …and judgement to make determinations whether requested services, requested level of care , and/or requested site of service should be authorized at the Inpatient ... communication of decisions to internal associates, and possible participation in care management. The clinical scenarios predominantly arise from inpatient or… more
- Takeda Pharmaceuticals (Columbus, OH)
- …in order to bring life-changing therapies to patients worldwide. Join Takeda as Associate Director, Global Labeling Lead where you will be responsible for the ... labeling requirements to be provided to patients and Health Care Providers while minimizing the risk of write-offs. +...to ensure consistency with the overall product strategy, product claims and information in the CCDS and to ensure… more
- The Cigna Group (Columbus, OH)
- …have a background in customer service or experience in healthcare, specifically benefits and claims processing, you might be the perfect fit to join our team as a ... Care Navigator Representative. As a Care Navigator,...driving a consistently accurate quality of service. **QUALIFICATIONS:** + Associate degree or higher required and/or 4+ years' work… more
- CVS Health (Columbus, OH)
- …more personal, convenient and affordable. **Position Summary** The Care Management Associate (CMA) role is a full-time remote telework position. Qualified ... with special healthcare needs and carries a caseload. The Care Management Associate supports comprehensive coordination of...+ May assist in the research and resolution of claims payment issues. Supports the administration of the hospital… more
- Molina Healthcare (Columbus, OH)
- …Technicians** who are State Licensed/Certified and/or PTCB certified. This role is 100% remote , and the hours will be **Mon-Fri 10am to 630pm Eastern Standard ... medical necessity for medications along with assisting with pharmacy claims . **Highly qualified candidates for this role will have...work within several computer systems at once + Managed care experience + High level of communication skills, both… more
- Molina Healthcare (Columbus, OH)
- …who is **BOTH** State Licensed/Certified and Nationally certified. This role is 100% remote , and the hours will be **Mon-Fri 11am to 730pm Central Standard Time** ... at once, MS Note experience a plus + Managed care experience + High level of communication skills, both...High School Diploma or GED equivalent **Preferred Education** : Associate degree **Required Experience** : 2 years' experience as… more
- Molina Healthcare (Columbus, OH)
- …to, and the appropriate approvals and escalations are achieved. Coordinates with both the Associate Vice President of Fraud, Waste and Abuse (FWA) and Associate ... Access, Word and Excel * Knowledge and understanding of claims processing systems and medical claims *...Master's degree **Preferred Experience** * Formalized training/experience in Health Care Insurance Fraud * Experience with Power BI, SAS,… more
- Abbott (Columbus, OH)
- …Our 114,000 colleagues serve people in more than 160 countries. ** Associate Scientist Product Development** **Working at Abbott** Our nutrition business develops ... you can do work that matters, grow, and learn, care for yourself and your family, be your true...creating new formulations which will deliver improvements to product claims , comply with regulatory requirements and/or reduce product cost.… more
- Humana (Columbus, OH)
- …and help us put health first** The Medical Coding Auditor reviews medical claims submitted against medical records provided, to ensure correct coding guidelines are ... payments in our payer systems, and by ensuring correct claims payment for appropriate CPT/ HCPCS code assignments. Analyzes,...**What Humana Offers** We are fortunate to offer a remote opportunity for this job. Our Fortune 100 Company… more
- Humana (Columbus, OH)
- …client services, client administration, customer service, enrollment, and eligibility, claims processing, and call center operations. Investigates and settles ... claims and customer service issues. Decisions are typically focus...to the Member + Collaborate with the Market and care Manager with GED Works on member needs. +… more
- Humana (Columbus, OH)
- …first** Humana's Clinical Analytics Team is seeking a Lead Research Scientist ( Remote ). Healthcare is rapidly changing, and our members are living longer, often ... clinical concepts and extract clinical information from medical, pharmacy, and lab claims for analytics and modeling purposes + Translates analytic results into key… more
- CVS Health (Columbus, OH)
- …of your health. This purpose guides our commitment to deliver enhanced human-centric health care for a rapidly changing world. Anchored in our brand - with heart at ... accelerating our ability to innovate and deliver solutions to make health care more personal, convenient and affordable. **Position Summary** **This is a full-time… more
- Humana (Columbus, OH)
- …processes + Solid understanding of healthcare operations, particularly around claims processing, enrollment, provider data management and clinical operations; ... Medicaid preferred + Comprehensive understanding of a Medicaid Managed Care architecture, tools, utilities and processes utilized to deliver on core competences +… more
- Humana (Columbus, OH)
- …first** The Corporate Medical Director relies on medical background and reviews health claims . The Corporate Medical Director works on problems of diverse scope and ... of established clinical experience + Knowledge of the managed care industry including Medicare, Medicaid and or Commercial products...protect member PHI / HIPAA information This is a remote position \#LI- Remote **Scheduled Weekly Hours** 40… more
- Humana (Columbus, OH)
- …working with health insurance operations related data to include enrollment, claims , billing and Reconciliation and/or contact center (Call center) data **Additional ... Information** **Work Style** : Remote **HireVue Statement** : As part of our hiring...(collectively, "Humana") offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and… more
- Humana (Columbus, OH)
- …Degree + CAS, MTV, PAAG, or APEX systems experience + Claims experience + Provider data management data loading/analysis/review **Additional information** ... ongoing interruptions to protect member PHI / HIPAA information. This is a remote position \#PPNO **Scheduled Weekly Hours** 40 **Pay Range** The compensation range… more