- Molina Healthcare (Dayton, OH)
- …and executing operational initiatives tied to Payment Integrity (PI) and provider claims accuracy. The individual will be relied upon to make independent, informed ... Analysis** + Uses a business lens to ensure accurate interpretation of provider claims trends, payment integrity issues, and process gaps. + Applies understanding of… more
- Sedgwick (Dayton, OH)
- …Adjuster - Mid Atlantic Region **PRIMARY PURPOSE** **:** To handle losses or claims nationally regardless of size, including having the ability to address any ... Account. **ESSENTIAL FUNCTIONS and RESPONSIBILITIES** + Examines insurance policies, claims , and other records to determine insurance coverage. + Administers… more
- Molina Healthcare (Akron, OH)
- …work on set schedule) Looking for a RN with experience with appeals, claims review, and medical coding. **Job Summary** Utilizing clinical knowledge and experience, ... Duties** + Performs clinical/medical reviews of retrospective medical claim reviews, medical claims and previously denied cases, in which an appeal has been… more
- Elevance Health (Mason, OH)
- …is responsible for auditing inpatient medical records and generating high quality recoverable claims for the benefit of the company, for all lines of business, and ... submitted DRG. **How you will make an impact:** + Analyzes and audits claims by integrating medical chart coding principles, clinical guidelines and objectivity in… more
- Sedgwick (Dublin, OH)
- …within an area. + Establishes and ensures compliance to best practices, claims management services standards, state regulations, and client service requirements. + ... AIC certifications preferred. Licenses as required. **Experience** Ten (10) years claims management experience or or equivalent combination of experience and… more
- Crossroads Hospice & Palliative Care (Green, OH)
- …completeness and obtain any missing information + Prepare, review, and transmit claims using billing software, including electronic and paper claim processing + ... Medicare, and state Medicaid + Follow up on unpaid claims within standard billing cycle timeframe + Check each...insurance or patient follow-up + Research and appeal denied claims + Answer all patient or insurance telephone inquiries… more
- Walmart (Washington Court House, OH)
- …Manages facilitylevel training and execution of asset protection safety and claims and receiving procedures by reviewing the application of policiesprocedures ... Determines training needs Develops and delivers training as needed Manages claims and receiving operations by ensuring proper policies and procedures are… more
- Bon Secours Mercy Health (Cincinnati, OH)
- …Assists in the review of Bon Secours Mercy Health coding, billing and claims processing policies and procedures for the development of compliance internal monitors ... periodic review and analysis of Bon Secours Mercy Health hospital claims denial reports, operational assessment reports, internal quality control reviews, internal… more
- Sedgwick (New Albany, OH)
- …Determines objective, quantifiable, medically supported work restrictions for assigned claims . + Facilitates return-to-work (RTW) and accommodation efforts through ... of return-to-work or job accommodation experience or three (3) years of claims management experience or equivalent combination of education and experience required.… more
- Prime Therapeutics (Columbus, OH)
- …to elicit, define, and document the requirements for changes to Prime's claims systems. **Responsibilities** + Ensure understanding of business requirements and IT ... and serve as subject matter expert and mentor for other members of Claims IT team, including cross-training assigned BSAs on system requirements phase of assigned… more