- Molina Healthcare (Covington, KY)
- …**Job Summary** Responsible for reviewing Medicaid, Medicare, and Marketplace claims for overpayments; researching claim payment guidelines, billing guidelines, ... and provider compliance. Interacts with health plans and vendors regarding recovery outstanding overpayments. **Job Duties** + Prepares written provider overpayment… more
- Sedgwick (Cincinnati, OH)
- …Great Place to Work(R) Most Loved Workplace(R) Forbes Best-in-State Employer Environmental Claims Specialist **Job Description Summary** To analyze complex or ... technically difficult environmental claims ; to provide resolution of highly complex nature and/or...+ Identifies and investigates for possible fraud, subrogation, contribution, recovery , and case management opportunities to reduce total claim… more
- Molina Healthcare (Covington, KY)
- …review to facilitate a referral to law enforcement or for payment recovery . **KNOWLEDGE/SKILLS/ABILITIES** + Reviews post pay claims with corresponding medical ... records to determine accuracy of claims payments. + Review of applicable policies, CPT guidelines,...+ AAPC Certified Medical CPC, CPMA, CPCO or similar specialist preferred + Certified Fraud Examiner and/or AHFI professional… more