- Molina Healthcare (Cincinnati, OH)
- …care or payer environment. + In-depth knowledge of medical and hospital claims processing, including CPT/HCPCS, ICD, and modifier usage. + Strong understanding of ... for this position, please apply through the Internal Job Board. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare … more
- Molina Healthcare (Columbus, OH)
- …and FQHC/RHC reports. + Generates other provider-related reports, such as: claims report extractions; regularly scheduled reports related to Network Management (ER, ... + 3-5 years managed care experience, including 2+ years in Provider Claims and/or Provider Network Administration. + 3+ years' experience in Medical Terminology,… more
- Capgemini (Cincinnati, OH)
- …Medicaid or Exchange program/ product build knowledge (Enrollment, Eligibility, Claims , Provider network, encounters etc) (Highly Recommended having exposure to ... one or many functions) E2E set of Pharmacy Benefits Experience in working with Plan and Pharmacy Benefits Manager Setting up Pharmacy call center Pharmacy member materials Provider Materials State Connections Manage large to high complexity programs… more
- KPH Healthcare Services, Inc. (Brecksville, OH)
- …+ Oversees the initial submission, resubmission and collection of all third party claims + Manages and balances the pharmacy inventory to ensure maximum turns while ... multiple factors such as relevant skills, years of experience and education. KPH Healthcare Services, Inc. is a multistate organization and abides by all local,… more
- ManpowerGroup (Westlake, OH)
- …C# .NET and Blazor. + Experience with health insurance companies or understanding of claims transactions and Healthcare EDI standards. **What's in it for me?** + ... Opportunity to work on complex and impactful software projects. + Collaborative and inclusive work environment that values diverse perspectives. + Professional growth through mentorship and leadership opportunities. + Engagement in strategic planning and… more
- KPH Healthcare Services, Inc. (Brecksville, OH)
- …the medication orders for various facilities. Ensuring that all Third-Party claims are billed properly. **Responsibilities** **Job Duties:** + Provides customer ... service and problem resolution to assigned facilities + Responsible for accurate data entry of patient profiles and medications + Maintaining accurate information for patients and facilities + Responsible for billing and crediting each facility appropriately… more
- KPH Healthcare Services, Inc. (Maumee, OH)
- …payersandobtainauthorizations as + Assist inthe preparationand submissionof claims for paymentfromthird party payers,andinvoices forpatientco-payments. + Support ... theresolutionofbilling issuessuch asclaim resubmissions toallpayers, changes incoverage,andclaims + Communicateasrequiredwithpatients about billing issues,including theresults ofapplications for financial hardshipassistanceand other responses… more
- CVS Health (Columbus, OH)
- …designs. + Completes financial forecasting and projection analysis to estimate future healthcare costs, revenue, and profitability. + Analyzes claims data to ... opportunities for cost containment, fraud detection, and quality improvement in claims processing and reimbursement. + Assesses impacts of new risk-sharing… more
- Sedgwick (Dublin, OH)
- …**_caring counts-and so do you._** **We're not just a global leader in claims management; we're a team driven by empathy, expertise, and impact. Right now, ... the go-to guide for individuals navigating the challenges of disability claims . Your role blends technical expertise with human connection-you'll interpret medical… more
- OhioHealth (Mansfield, OH)
- …Description Summary:** Given that the organization self-insures for professional liability claims , it is essential that the Sr Consultant Risk Management effectively ... patient outcomes that have the potential to progress to professional liability claims against the hospital; analyze, interpret, and generate reports regarding the… more