- Humana (Harrisburg, PA)
- …by utilizing code editing guidelines and data anomalies to ensure correct claim payment. The Senior Payment Integrity Professional work assignments require in-depth ... and opportunities for improvement. Partners with internal business partners to support business initiatives, including identifying the root cause of challenges,… more
- AscellaHealth (Berwyn, PA)
- …to Prior Authorization denials and submit appeals, collecting appropriate clinical support to substantiate the formal response. + Compose technical denial arguments ... and verbal. + Overcome objections that prevent payment of claims and gain commitment for payment through a concise...and escalate where appropriate. + Utilize documentation standards that support a strong historical record of actions taken. +… more
- WellSpan Health (York, PA)
- …appropriate ICD-10 diagnoses codes following established organizational guidelines and to support medical necessity + Follows Official Guidelines for Coding and ... appropriate course of action. + Works assigned Epic Account, Charge Review or Claim Edit work queues to identify and investigate Epic edits for coding errors,… more
- Zurich NA (Philadelphia, PA)
- …School Diploma or Equivalent and 6 or more years of experience in the Claims or Underwriting Support areaOR + Zurich Certified Insurance Apprentice including an ... an Associate Degree and 4 or more years of experience in the Claims or Underwriting Support areaAND + Knowledge of line/s of business and the legal and… more
- Zurich NA (Philadelphia, PA)
- …School Diploma or Equivalent and 6 or more years of experience in the Claims or Underwriting Support areaOR + Zurich Certified Insurance Apprentice including an ... an Associate Degree and 4 or more years of experience in the Claims or Underwriting Support area AND + Knowledge of line/s of business and the legal and… more
- Zurich NA (Philadelphia, PA)
- …School Diploma or Equivalent and 6 or more years of experience in the Claims or Underwriting Support areaOR + Zurich Certified Insurance Apprentice including an ... an Associate Degree and 4 or more years of experience in the Claims or Underwriting Support areaAND + Knowledge of line/s of business and the legal and… more
- Commonwealth of Pennsylvania (PA)
- …by service providers, insurers, and other applicable sources, as well as claims and related information to make professional judgments regarding Medical Assistance ... review process, as well as provide advisory and consultative support to MA policy and other DHS staff to...attach a copy of your college transcripts for your claim to be accepted toward meeting the minimum requirements.… more
- Naval Foundry and Propeller Center (Philadelphia, PA)
- …a highly skilled and versatile workforce of engineers, trades people and support personnel who specialize in advanced engineering, castings, and precision machining. ... for mitigation actions. Perform investigations to document reasons for modification, claim , and/or administration or scheduling errors. Consults with stake holders… more
- Penn Medicine (Philadelphia, PA)
- …Verification of benefits and pre-certify selected outpatient registrations. Provide specialized support in the areas of insurance and billing information. Support ... administrator as needed to obtain complete, accurate financial information required for claim adjudication + Any discrepancies to be immediately communicated to unit… more
- Philips (Malvern, PA)
- …benefits and justify investments. Review and finalize these propositions to support decision-making and align with business strategies and future portfolio changes. ... as feature descriptions, value propositions, and cost materials. + Coordinate claim roadmap development by collaborating with cross-functional teams to prioritize … more