- Molina Healthcare (Columbus, OH)
- …Partners to ensure resolution within 30 days of error issuance. * Evaluates the adjudication of claims using standard principles and state specific policies and ... clear and concise to ensure accuracy in auditing of critical information on claims ensuring adherence to business and system requirements of customers as it pertains… more
- CRC Insurance Services, Inc. (OH)
- …fostering great working relationships with insureds, brokers and underwriters in the handling and adjudication of all claims . 8. Maintain claims and suspense ... America) **Please review the following job description:** Analyzes and processes claims by gathering information and drawing conclusions. Manages and evaluates… more
- Molina Healthcare (Cincinnati, OH)
- …release notes to accurately request and analyze impact reports of affected claims . + Analyzes, interprets, and maintains configurable tables and files that support ... claim adjudication rules, benefit plan support, and provider reimbursement rules....or reimbursement processes + Experience processing or reviewing facility claims + Prior professional experience utilizing Microsoft Excel (eg,… more
- Molina Healthcare (Dayton, OH)
- …agile system development lifecycle methodologies **Knowledge:** + Experienced in working with claims and claim configuration teams to streamline adjudication and ... recovery processes + Direct PM experience in Managed Care Operations ( claims , system configuration, provider data management preferred) + Demonstrated ability to… more
- Prime Therapeutics (Columbus, OH)
- …work visa or residency sponsorship **Additional Qualifications** + Understanding the adjudication process + Strong verbal and written communication skills + Ability ... platforms and products + Experience using queries, thorough understanding of pharmaceutical claims data and general understanding of medical claims data; highly… more
- Highmark Health (Columbus, OH)
- …medication requests, and drug claim edits/prior authorizations. By reviewing member claims history, clearly defines the medical necessity of non-formulary and prior ... Enter all authorizations into the Argus IPNS information system to allow claim adjudication . + Complete other assigned duties as specified. + Identify and report… more
- Humana (Columbus, OH)
- …enforcement authorities. Assembles evidence and documentation to support successful adjudication , where appropriate. Conducts on-site audits of provider records ... Certifications, CPC, CCS, CFE, AHFI). + Understanding of healthcare industry, claims processing and investigative process development. + Experience in a corporate… more