- Molina Healthcare (Columbus, OH)
- …and timely validation and maintenance of critical provider information on all claims and provider databases. Staff ensure adherence to business and system ... care experience + Experience in one or more of the following: Claims , Provider Services, Provider Network Operations, Hospital or Physician Billing, or similar.… more
- Elevance Health (Columbus, OH)
- …with fraud and abuse. **How you will make an impact:** + Examines claims for compliance with relevant billing and processing guidelines and identifies opportunities ... prevention and control. + Reviews and conducts analysis of claims and medical records prior to payment and uses...in good faith believes is the range of possible compensation for this role at the time of this… more
- Robert Half Accountemps (Massillon, OH)
- …Key Responsibilities: + Handle full-cycle medical billing processes, including coding, claims submission, and resolving denied claims . + Perform follow-ups ... and rebilling to secure timely resolutions for outstanding claims . + Assist the Human Resources team with annual...to succeed. We provide access to top jobs, competitive compensation and benefits, and free online training. Stay on… more
- Elevance Health (Mason, OH)
- …of utilization and/or fraudulent activities by health care providers through prepayment claims review, post payment auditing, and provider record review. **How you ... potential fraud and over-utilization by performing medical reviews via prepayment claims review and post payment auditing + Correlates review findings with… more
- Molina Healthcare (Columbus, OH)
- …for accurate and timely maintenance of critical provider information on all claims and provider databases. Maintains critical provider information on all claims ... but not limited to, Configuration, Business Systems, Encounters (inbound and outbound), Claims , Provider Services and Contracting. + Assist in design and development… more
- Prime Therapeutics (Columbus, OH)
- …with high-complexity pricing analyses. **Responsibilities** + Analyze and produce pharmacy claims data reporting of varying complexity to assess competitiveness & ... accuracy of Prime's financial pricing programs against adjudicated claims to identify trends and draw insights to provide pricing recommendations + Apply… more
- Elevance Health (Mason, OH)
- …eligible for employment based sponsorship. **Ensures accurate adjudication of claims , by translating medical policies, reimbursement policies, and clinical editing ... to system inquiries and appeals. + Conducts research of claims systems and system edits to identify adjudication issues...be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with… more
- CGI Technologies and Solutions, Inc. (Columbus, OH)
- …management and accurate completion of Section 8 voucher processing and special claims review. Approval of monthly vouchers, submit approved vouchers and tenant data ... - Accurate completion of Section 8 Vouchers and special claims for assigned portfolio. - Ensures the financial performance...some jurisdictions to include a reasonable estimate of the compensation range for this role. The determination of this… more
- Sedgwick (Columbus, OH)
- …support systems. + Effectively communicates and builds relationships with the claims ' examiner, client, injured worker, attorney and supervisor. + Identifies issues ... required by law, Sedgwick provides a reasonable range of compensation for roles that may be hired in jurisdictions...other roles.** **Sedgwick is the world's leading risk and claims administration partner, which helps clients thrive by navigating… more
- Sedgwick (Columbus, OH)
- …of all aspects of property, casualty, and disability TPA services including claims , managed care, and ancillary services such as alternative risk to support ... required by law, Sedgwick provides a reasonable range of compensation for roles that may be hired in jurisdictions...other roles.** **Sedgwick is the world's leading risk and claims administration partner, which helps clients thrive by navigating… more
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