- Guidehouse (Tampa, FL)
- …of assigned Medicare and third-party payer accounts that are subject to pre-bill claim edits, hospital billing scrubber bill hold edits, and claim denials. ... include: + Responsible for the daily resolution of assigned claims with applicable Revenue Integrity pre-bill edits and/or specific...Unlikely Edits (MUE) + Medical Necessity edits + Other claim level edits as assigned + As needed, review… more
- Molina Healthcare (St. Petersburg, FL)
- …agencies to ensure that internal and/or regulatory timelines are met. * Researches claims appeals and grievances using support systems to determine appropriate ... Researches claims processing guidelines, provider contracts, fee schedules and systems configurations, to determine root causes of payment errors. * Resolves and… more
- Molina Healthcare (Tampa, FL)
- …all payment integrity (PI) solutions. * Independently leads efforts to improve claim payment accuracy, claim referrals, adjustment analysis and financial ... Analysis_ * Uses a business lens to ensure accurate interpretation of provider claims trends, payment integrity issues, and process gaps. * Applies understanding of… more
- Modernizing Medicine (Boca Raton, FL)
- … claim states, and support the development of AI-driven decision support systems that recommend next-best actions throughout the claim workflow. Your Role: ... will focus on advancing intelligent automation across the clinical and healthcare claims data lifecycle. The intern will work with cutting-edge generative AI and… more
- Molina Healthcare (Jacksonville, FL)
- …maintain contract, benefit or reference table information into the claim payment system and other applicable systems . + Participates in defect resolution for ... claims databases. Synchronizes data among operational and claims systems and application of business rules...housed on databases and ensure adherence to business and system requirements of customers as it pertains to contracting,… more
- Prime Therapeutics (Tallahassee, FL)
- …and document the requirements and technical solutions for changes to Prime's claims systems . **Responsibilities** + Ensure understanding of business requirements ... to elicit and document business needs for moderately complex modifications to Claims system applications, and define functional, high-level, and detailed … more
- City of Lakeland (Lakeland, FL)
- …maintaining related files and records, and performing various insurance, claims processing, safety, and loss prevention functions. Work involves processing ... records, reporting risk management statistics, and handling property and casualty claims . This position is responsible for maintaining litigated files and… more
- Sedgwick (Orlando, FL)
- …and professionally with claimants and clients by phone, written correspondence and/or claims system . + Maintains professional client relationships and provides ... based on client plans, state and federal regulations. Ensures that on-going claim management is within company service standards and industry best practices.… more
- Cardinal Health (Tallahassee, FL)
- … claims processing. + Manages billing queue as assigned in the appropriate system . + Manages and resolves complex insurance claims , including appeals and ... in accordance with company policy, regulations, or third-party policy. + More challenging claim cases + Investigates and updates the system with all information… more
- Elevance Health (Tampa, FL)
- …claim identification, and documentation purposes (eg, letter writing). + Identifies new claim types by identifying potential claims outside of the concept ... or quality assurance environment preferred. + Broad knowledge of medical claims billing/payment systems provider billing guidelines, payer reimbursement… more
Recent Jobs
-
Product Engineering | PxE A&A | Cloud Architect
- Deloitte (Tampa, FL)
-
(USA) Operations Manager - Floor (fashion, Import, Jewelry, Regional, Returns, Sam's, Wm.com, Hmsc)
- Walmart (Laurens, SC)
-
Oracle Health - Senior Interoperability Project Manager
- Oracle (Des Moines, IA)