- Commonwealth of Pennsylvania (PA)
- …questions, you must attach a copy of your college transcripts for your claim to be accepted toward meeting the minimum requirements. Unofficial transcripts are ... Select the Level of Performance that best describes your claim . + A. I have professional experience related to...addresses the items listed below which relate to your claim . If you indicated you have no work experience… more
- Commonwealth of Pennsylvania (PA)
- …questions, you must attach a copy of your college transcripts for your claim to be accepted toward meeting the minimum requirements. Unofficial transcripts are ... Select the Level of Performance that best describes your claim . + A. I have professional experience related to...addresses the items listed below which relate to your claim . If you indicated you have no work experience… more
- Centene Corporation (Pittsburgh, PA)
- …reviewing, investigating and tracking member grievances and appeals, and provider claims disputes. Responsible for coordinating as necessary with the G&A ... member grievances and complaints + Screen all incoming grievances, appeals and provider claim disputes to ensure they are in compliance with the Arizona Revised… more
- BrightSpring Health Services (Bethlehem, PA)
- …calculations, including dosage and conversion tasks. + Investigate and resolve pharmacy claim denials; perform follow-up actions in POS systems. + Stay current with ... Medicaid claim regulations and ensure compliance in processing. + Track...ensure compliance in processing. + Track unpaid or delayed claims ; generate reports for management. + Provide excellent customer… more
- CVS Health (Harrisburg, PA)
- …monthly invoices in accounting system. + Enter and process monthly fee claims for ancillary product offerings via claim system. **Required Qualifications** ... + 2+ years of experience working in an accounting system, including accounts receivable, accounts payable, auditing, and billing. **Preferred Qualifications** + Resides in Amherst, New York, with the ability to work a hybrid schedule in the local office. +… more
- CVS Health (Harrisburg, PA)
- …data into meaningful and actionable information. This role is responsible for medical claims and economics reporting and analytics for a book of Middle Market and ... cost, basic provider/network concepts, partnering with PSL on operational claim research. + Relationship management: Demonstrated relationship management skills at… more
- Highmark Health (Harrisburg, PA)
- …dental offices. Formally present and effectively communicate UCD's administrative and claim guidelines and policies, benefits of participation, fee schedules, plan ... ensure they utilize various means of automated communication, as well as, claims and electronic data interchange and electronic funds transfer. Collaborate with… more
- Globus Medical, Inc. (Audubon, PA)
- …employees. This role serves as a primary contact for employee inquiries, claim research, and issue resolution, ensuring compliance with applicable laws, regulations, ... Administer Short-term/Long-term Disability and Family and Medical Leave Act (FMLA) claims , including tracking and documentation. + Manage workers' compensation … more
- UPMC (Pittsburgh, PA)
- …insurers and patients. Account Representatives, Senior are responsible to: ensure claims are submitted accurately and timely; communicate with insurance companies, ... steps to eliminate future occurrences of denials. Assist in claim appeal process and/or perform follow-up in accordance with...defined by management. + Must have 1 year of claims /billing/collections experience; + OR 4 years in a business… more
- CVS Health (Harrisburg, PA)
- …analyses to support investigations of potential fraud, waste, and abuse in Medicaid claims and provider activity. + Prepare timely and accurate Medicaid regulatory & ... to non-technical audiences. + 2+ years experience interpreting medical claim data + Advanced experience in SQL & Python...fraud, waste and abuse + Knowledge of Medicaid healthcare claims adjudication (QNXT) & regulatory reporting + Experience with… more