- Highmark Health (Madison, WI)
- …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
- IQVIA (Milwaukee, WI)
- …orally and in writing with a customer. o Research and resolve Chargeback claims . o Ensure accurate and appropriate responses to disputes. o Validate appropriate data ... Experience with the following is preferred but not required: o Chargeback Adjudication o Membership and Eligibility determinations o Prescription Rebate Processing o… more
- Datavant (Madison, WI)
- …on payer policy changes, CMS updates, and healthcare regulations affecting claim adjudication . **What you will bring to the table:** + Associate's or Bachelor's ... collections. + Proficient in Microsoft Office Suite (especially Excel), EHRs, claims editing software, and data analytics tools. + Exceptional analytical,… more