- Molina Healthcare (Dallas, TX)
- …of critical information on claims databases. Synchronizes data among operational and claims systems and application of business rules as they apply to each ... **KNOWLEDGE/SKILLS/ABILITIES** + Analyze and interpret data to determine appropriate configuration changes. + Accurately interprets specific state and/or federal… more
- Huron Consulting Group (Chicago, IL)
- …Evidence of Coverage (EOC), and Summary of Benefits into accurate, system-ready configuration specifications. + Partner with Product, Claims , Enrollment, and IT ... growth, optimize internal processes and deliver better consumer outcomes. Health systems , hospitals and medical clinics are under immense pressure to improve… more
- CareFirst (Baltimore, MD)
- …membership configuration set-up and maintenance, setup of code sets used for configuration in benefits & pricing for claims processing, claims editing ... core care management and clinical appeals workflows. + Assesses how proposed configuration management changes may impact systems sustainment and supportability… more
- Huron Consulting Group (Chicago, IL)
- …growth, optimize internal processes and deliver better consumer outcomes. Health systems , hospitals and medical clinics are under immense pressure to improve ... and create your future. Huron is looking for a highly skilled NetworX Configuration SME to oversee the configuration , maintenance, and optimization of provider… more
- Commonwealth Care Alliance (Boston, MA)
- …or configuration updates. + Document all research, findings, and outcomes in claims systems (eg, Salesforce, Facets) in compliance with audit standards and ... 011250 CCA- Claims **_This position is available to remote employees...Provider Relations, Contracting, Payment Integrity, Appeals & Grievances, and Configuration teams to validate and resolve reimbursement concerns. +… more
- Molina Healthcare (Meridian, ID)
- …issues. This role will require actively researching issues to adjudicate claims Requires knowledge of operational areas and systems . ... + This role is involved in member enrollment, provider information management, benefits configuration and/or claims processing. + Responds to incoming calls from… more
- Otsuka America Pharmaceutical Inc. (Princeton, NJ)
- **Job Summary** The Associate Director, Communications Engineer designs, implements, manages, and maintains network communications systems and supporting ... platforms and networking environments. + Designs and implements network communications systems such as Blackberry, and client remote access systems .… more
- UPMC (Pittsburgh, PA)
- UPMC Health Plan has an exciting opportunity for a QA Anlyst, Associate in the Operatonal Risk Integrity department. This is a full time position working Monday ... working from home and in the office two days per week. The Insurance Auditor Associate is primarily responsible for the review of high dollar claims and… more
- Molina Healthcare (Orem, UT)
- …information on all claims and provider databases. Synchronizes data among multiple claims systems when available, and the application of business rules as ... demographic information and coordinates communication of such information to Provider Configuration team. * Sends out new provider welcome packets to providers… more
- Sharp HealthCare (San Diego, CA)
- … claims , provider, billing, capitation, financial and structural. The Systems Analyst-EDI Mgmt will work to streamline processes, create efficiencies and ... Will Do** Under the direction of the Manager of EDI Management, the Systems Analyst-EDI Mgmt will use technical and analytic skills to complete monitoring,… more
- CareFirst (Baltimore, MD)
- …operational technology support, Utilization Management (UM) operations, Clinical Product Configuration , Health Plan Claims /Authorization workflows, or related ... projects as needed. Maintain a strong working knowledge of the FACETS claims -to-authorization matching workflow and utilize this knowledge to identify and resolve… more
- Henry Ford Health System (Troy, MI)
- …and HAP code-related committee meetings to resolve coding questions related to claims , configuration , benefits, new technology, fraud, compliance, and any other ... issue. Aside from committee meetings, assist with claims resolution issues as needed. + Assist in requesting...needed. + Assist in requesting and tracking any system configuration changes completed by the Benefit Configuration … more
- AmeriHealth Caritas (Charleston, SC)
- …maintenance knowledge. + Required understanding of and experience related to healthcare claims payment configuration process/ systems and its relevance/impact ... and provider billing requirements and as liaison to the Enterprise Operations Configuration Department. + Maintain a current working knowledge of processing rules,… more
- UIC Government Services and the Bowhead Family of Companies (Oklahoma City, OK)
- …highly preferred + Two plus(2+) years professional, relevant experience. + Associate 's Degree in Management Information Systems , Computer Science, or ... and software, including printing, installation, word processing, electronic mail, and operating systems . The IT Helpdesk Agent will be responsible for working Day,… more
- CareFirst (Baltimore, MD)
- …capture and proper use of CPT, HCPCS, and ICD 10 codes in claims submissions. Utilizes coding expertise, combined with medical policy, credentialing, and contracting ... and platforms. The Senior Coding Analyst partners with medical policy analysts, configuration teams, and payment integrity staff to support the accurate, timely, and… more
- UIC Government Services and the Bowhead Family of Companies (Everett, WA)
- …Operate and maintain government-owned **telephony switches (PBX)** , including: + **Avaya Systems CM4.0** + Perform: + Troubleshooting and repair of switch issues + ... Software updates and patching + Installation and configuration of switch hardware + Daily operation monitoring +...hardware + Daily operation monitoring + Support for voicemail systems and IPE (Remote Intelligent Peripheral Equipment) + Utilize… more
- CareFirst (Baltimore, MD)
- …application. This role plays a critical part in enabling seamless integration, configuration , and performance of core payer functions like enrollment, claims , ... APIs, and data exchange using EDI/X12 and flat files. + Evaluates new systems by performing in-depth tests, including end-user reviews. Research software and related… more
- Geisinger (Danville, PA)
- …reporting, Billing/Enrollment Operations support, Finance Operations support, system configuration , processing of TPA capitation payments, automation requests and ... capitation system for financial reporting. + Provides direct support to the configuration , maintenance and operation of the billing and capitation system, including… more
- Zurich NA (Schaumburg, IL)
- …+ Implementation: Lead or support SAP FSRI implementation projects, including configuration , customization, and integration with other SAP modules (eg, FI, CO, ... Optimization: Identify opportunities to automate and improve reinsurance accounting, claims , and reporting processes. + Stakeholder Collaboration: Work closely with… more
- Lowe's (Westfield, MA)
- …Fulfillment Center (FFC). Your day involves reviewing calls, emails, and claims , providing status updates, processing special orders, and monitoring load plans ... Improvement - collaborate with cross functional teams to optimize warehouse systems for improved efficiency and operational service levels. + Create processes… more