- Humana (Columbus, OH)
- …and help us put health first** The Medical Coding Auditor reviews medical claims submitted against medical records provided, to ensure correct coding guidelines are ... Office, ER, Telehealth, Home Health, and minor procedures + Experience with the Claims Life Cycle + Experience with coding/auditing Professional Inpatient Claims … more
- Molina Healthcare (Dayton, OH)
- …including accurate and timely maintenance of critical provider information on all claims and provider databases. Synchronizes data within multiple claims systems ... Ensures that provider information is loaded accurately to ensure proper claims processing, outbound reporting and directory processes. **Required Qualifications** *… more
- Molina Healthcare (Akron, OH)
- …executive decision-making + Mine and manage information from large data sources. + Analyze claims and other data sources to identify early signs of trends or other ... of provider reimbursement changes + Provide data driven analytics to Finance, Claims , Medical Management, Network, and other departments to enable critical decision… 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 ... the intranet job listing. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.… more
- Sedgwick (Dayton, OH)
- …designation required. Experience: Ten (10) years of relationship building in the claims management or risk management area or equivalent combination of education and ... 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
- Molina Healthcare (OH)
- …executive decision-making + Mine and manage information from large data sources. + Analyze claims and other data sources to identify early signs of trends or other ... of provider reimbursement changes + Provide data driven analytics to Finance, Claims , Medical Management, Network, and other departments to enable critical decision… more
- Fifth Third Bank, NA (Cincinnati, OH)
- …previously filed dispute. This may include specialized disputes, including denied claims , reassertions, repeat offenders, and Private Bank client customers. The ... compliance with Uniform Commercial Code (UCC) and Regulation E and Regulation Z claims . The Analyst uses various bank and vendor systems to research questions… more
- Elevance Health (Mason, OH)
- …healthcare fraud in order to recover corporate and client funds paid on fraudulent claims . **How you will make an impact:** + Claim reviews for appropriate coding, ... and claim systems for review of facility, professional and pharmacy claims . + Responsible for independently identifying and developing enterprise-wide specific… more
- Prime Therapeutics (Columbus, OH)
- …Recommend new and revised financial pricing programs based on analysis of pharmacy claims data, average wholesale drug prices (AWP), and other relevant data of ... data + Develop financial pricing models to monitor performance against pharmacy claims data and identify financial pricing opportunities to drive savings and/or meet… more
- Walmart (Beavercreek, OH)
- …area in accordance with company policies and procedures by properly handling claims and returns utilizing equipment to perform a variety of merchandising functions ... fulfillment process when necessary by processing information for thirdparty insurance claims rescanning illegible images alerting patients to inventory that is out… more
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