- Humana (Richmond, VA)
- …of our caring community and help us put health first** The Senior Pharmacy Claims Operations Professional oversees the business processes and ensures ... sale transition adjudicated claims logic. The Senior Pharmacy Claims Operations Professional work assignments involve moderately complex to complex… more
- CVS Health (Richmond, VA)
- …people on their path to better health as part of the largest integrated pharmacy company in the United States. Through the company's more than 7,600 CVS/ pharmacy ... a market leader in mail order, retail and specialty pharmacy , retail clinics, and Medicare Part D Prescription Drug...be responsible for: Managing a high volume of medical claims that have denied by refuting the denials within… more
- Humana (Richmond, VA)
- …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
- VHC Health (Alexandria, 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
- Chesapeake Regional Healthcare (Chesapeake, VA)
- …services, home health care services, durable medical equipment, rehabilitative therapies, and pharmacy reviews from finance and/or claims department + Prepare ... record and other applicable hospital documentation, assigning modifiers to appropriate claims , researching edited claims for medical necessity, and advising… more
- Elevance Health (Norfolk, VA)
- … claims processing, enrollment, and benefit administration. + Experience with pharmacy prescription drug claims testing, benefits and clinical testing + ... work here will be Test Program Management for our pharmacy business system integrations. **Location:** This position will work...skills. + Ability to prepare status and metrics to senior leadership team. + Ability to work in a… more
- Elevance Health (Roanoke, VA)
- …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
- Cardinal Health (Richmond, VA)
- …a deep understanding of healthcare reimbursement (managed care and specialty pharmacy operations). In addition to stewarding relationships with the pharmaceutical ... + Knowledge of the specialty drug product marketplace, health insurance claims processing, and commercialization of products and working with pharma manufacturers… more