- Molina Healthcare (Green Bay, WI)
- **JOB DESCRIPTION** **Job Summary** Responsible for administering claims payments, maintaining claim records, and providing counsel to claimants regarding coverage ... amount and benefit interpretation. Monitors and controls backlog and workflow of claims \. Oversees analysis of complex claim inquiries and reimbursement issues using… more
- Molina Healthcare (Racine, WI)
- …**Job Summary** Within a Contact Center setting, responsible for administering claims payments, maintaining claim records, and providing counsel to claimants ... coverage amount and benefit interpretation. Monitors and controls backlog and workflow of claims . Ensures that claims are settled in a timely fashion and… more
- Elevance Health (Waukesha, WI)
- **External Audit Facilitator** **Location:** This role requires associates to be in-office 1-2 days per week, fostering collaboration and connectivity, while ... a dynamic and adaptable workplace. Alternate locations may be considered. The **External Audit Facilitator** is responsible for managing the process for claims … more
- Molina Healthcare (WI)
- …for accurate and timely maintenance of critical provider information on all claims and provider databases. Maintains critical provider information on all claims ... timely manner to meet department standards of turnaround time and quality. + Audit loaded provider records for quality and financial accuracy and provide documented… more
- Elevance Health (Waukesha, WI)
- …Group (DRG) methodology, including case rate and per diem, generating highly complex audit findings recoverable claims for the benefit of the Company, for ... appeals may only be reviewed by other DRG Coding Audit Principals (or Executives). **How you will make an...you will make an impact:** + Analyzes and audits claims by integrating advanced or convoluted medical chart coding… more
- Molina Healthcare (WI)
- …of a formal appeal being submitted. + Independently re-evaluates medical claims and associated records by applying advanced clinical knowledge, knowledge of ... the specific programs supported by the plan such as Utilization Review, Medical Claims Review, Long Term Service and Support, or other specific program experience as… more
- Elevance Health (Waukesha, WI)
- …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
- Highmark Health (Madison, WI)
- …responsible for assisting in the processing and investigation of non-complex health care claims to determine the legitimacy of claim charges. The incumbent will also ... services and charges; will monitor internal referrals from sources such as claims , customer service, Medicare C&D Compliance, and Fraud Hotlines; will alert… more
- Highmark Health (Madison, WI)
- …OVERVIEW:** Performs all related internal, concurrent, prospective and retrospective coding audit activities. Reviews medical records to determine data quality and ... identified in the audits compliant with regulatory requirements. Provides written audit guidance. Participates with management in the assessment of external … more
- Humana (Madison, WI)
- …for Medicare and Medicaid claims ) + Experience with Auditing and monitoring of healthcare records + Must be able to work core business hours on EST time between ... Compliance team that supports the PCO is responsibility to assess, investigate, audit and validate the mitigation of compliance risk across the organization. This… more
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