- CRC Insurance Services, Inc. (OH)
- …(United States of America) **Please review the following job description:** Process claims , which includes evaluating policy for coverage; working with the insured, ... adjusters, agents and attorneys on the claim and coordinating the payment of claims . In addition, prepare reports such as loss runs and monthly bordereau.… more
- Molina Healthcare (OH)
- …Responsible for conducting various audits including, but not limited to; vendor, focal, audit the auditor. Confirm that documentation is 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 to contracting (benefit and… more
- Molina Healthcare (Dayton, OH)
- …Lead Analyst, Configuration Oversight to support our Payment Integrity and Claims Operations teams in ensuring the accuracy and compliance of Coordination ... guidance. The ideal candidate will bring deep knowledge of claims adjudication, QNXT system navigation, and strong analytical acumen....+ Assist in developing and refining internal SOPs and audit tools related to COB claim reviews. + Act… 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
- Elevance Health (Mason, OH)
- …and DRGs billed and reimbursed. Specializes in review of Diagnosis Related Group (DRG) paid claims . **How you will make an impact:** + Analyzes and audits claims ... coding principles, clinical guidelines, and objectivity in the performance of medical audit activities. + Draws on advanced ICD-10 coding expertise, mastery of… more
- Molina Healthcare (OH)
- …and other guidance to assess compliance and support building regulatory compliance audit procedures. * At the direction of management, coordinates and performs ... with developing the Operational Oversight Work Plan, monitoring and reporting status of audit project tasks, and reporting on overall status of audit projects.… 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
- Otsuka America Pharmaceutical Inc. (Columbus, OH)
- …ready, oversee clinical trial and submission support, lead the R&D audit program, engage with regulatory authorities, and maintain clinical data integrity. ... sites, and vendors (including contract research organizations) and ensure that audit results are communicated, and appropriate corrective actions are implemented and… more
- Molina Healthcare (Akron, OH)
- …and executing operational initiatives tied to Payment Integrity (PI) and provider claims accuracy. The individual will be relied upon to make independent, informed ... + Manages Scorable Action Items (SAIs) related to pre-pay editing, post-pay audit , and overpayment recovery initiatives to ensure Health Plan SAI targets are… more
- Sedgwick (Dayton, OH)
- …& Insurance OSS Coordinator **PRIMARY PURPOSE** : To support and maintain the claims management system for a local office or multiple office locations; and to ... claim adjustments, provider requests and operational expense check requests. + Queues claims for Managed Care; transfers payment allocations; and runs manual pre-pay… more