- Walgreens (Westerville, OH)
- …technology. Finds opportunities to improve productivity + Ensures insurance claims are processed accurately to prevent payment rejections. Resolves patient ... issues by working with insurance companies and medical providers and conducting or participating in third party audits. + Follows-up with medical providers to clarify prescribed medications, dosages, refills, interactions, and allergies to suggest alternative… more
- Meijer (West Chester, OH)
- …pharmacy dispensing system. + Creating prescription labels and adjudicating insurance claims . + Completing paperwork related to filling prescriptions and receiving ... drug orders. + Ordering prescription medication for the Pharmacy Department. + Stocking prescription medication. + Promoting pharmacy initiatives and clinical services to the customer. + Prioritizing workload. + Using effective communication skills and be… more
- Molina Healthcare (Akron, OH)
- …focused reviews and recommends corrective actions. + Conducts retrospective reviews of claims and appeals and resolves grievances related to medical quality of care. ... + Attends or chairs committees as required such as Credentialing, P&T and others as directed by the Chief Medical Officer. + Evaluates authorization requests in timely support of nurse reviewers; reviews cases requiring concurrent review, and manages the… more
- Elevance Health (Cincinnati, OH)
- …and models data including risk reporting and forecasting. + Calculates monthly claims liability reserves, develops merit rating factors and prepares Department of ... Insurance annual statement exhibits. + Leverage and expand your expertise in Excel and SAS, with the opportunity to enhance your skills in R, as you contribute to impactful projects that drive innovation and efficiency in healthcare solutions. **Minimum… more
- Molina Healthcare (Dayton, OH)
- …affordably. Performs research, financial modeling, and analysis of complex healthcare claims data (medical, pharmacy and ancillary) to deliver practical, actionable ... financial and even clinical insights to focus high priorities and attack underperforming and problematic contracts. Supports multi-dimensional pricing strategies to drive down total cost of care and minimize variation in cost by leveraging value-based care… more
- ABM Industries (Columbus, OH)
- …way and that the accident is promptly reported to the District Manager, Safety, Claims and Customer. + Looks for root causes of accidents and communicates findings ... to the District Manager first then to the customer in an effort to eliminate or mitigate the causes in the future. + Counsels, trains or disciplines employees as appropriately when they have caused an accident or are observed doing the job in an unsafe manner.… more
- Molina Healthcare (Akron, OH)
- …and software programs. * Must have a deep understanding of the Claims , Encounters, Pharmacy, Enrollment, Supplemental data etc. processes to assure data validation, ... audit and management. **Preferred Education** Master's Degree in a clinical field, IT, Public Health or Healthcare Administration **Preferred Experience** * RADV and Risk Adjustment improvement experience * State related risk adjustment experience * 3+ years… more
- Saia, Inc (Mansfield, OH)
- …trailer combinations over long distances to deliver freight in a safe, claims -free, and cost-efficient manner. **Major Tasks and Responsibilities** + Drives tractor ... trailers to deliver and pickup freight between company terminals, customer facilities, or meeting points. + Travels regionally and cross-regionally while pulling single, double, or triple trailers. + Follows established pre-trip, post-trip, freight handling,… more
- Elevance Health (Mason, OH)
- …Cost of Care and/or Provider Contracting organizations. Focuses efforts on lowering claims costs, improving the quality of care, and increasing member and provider ... network satisfaction. **How you will make an impact:** + Provides expert advice, analytic and consultative support to Medical Directors and management on cost of care issues. + Works on large scale initiatives with high dollar cost savings opportunities. +… more
- Elevance Health (Mason, OH)
- …provide an equivalent background. **Preferred Skills, Capabilities and Experiences:** + Claims experience preferred. + FEP knowledge preferred. + Experience managing ... a remote staff preferred. _For URAC accredited areas, the following professional competencies apply: Associates in this role are expected to have strong oral, written and interpersonal communication skills, problem-solving skills, facilitation skills, and… more