- ProMedica Health System (Toledo, OH)
- …work with management to resolve. 17. Maintains current payor knowledge for effective claims management and follow up of unresolved claims . 18. Routinely reviews ... of Professional charging processes * Experience with follow-up daily on post processing activity including but not limited to, rejected billings, adjustments, and… more
- Otsuka America Pharmaceutical Inc. (Columbus, OH)
- …federal laws, regulations and guidelines including PhRMA Code on Interactions with Healthcare Professionals as well as complying with all OAPI standards and policies ... offered money for equipment fees or some other application processing fee, even if claimed you will be reimbursed,...you will be reimbursed, this is not Otsuka. These claims are fraudulent and you are strongly advised to… more
- Otsuka America Pharmaceutical Inc. (Columbus, OH)
- …or government relations consulting firm. Strong understanding of US healthcare system and regulatory environment is preferred. Excellent interpersonal skills ... offered money for equipment fees or some other application processing fee, even if claimed you will be reimbursed,...you will be reimbursed, this is not Otsuka. These claims are fraudulent and you are strongly advised to… more
- CVS Health (Columbus, OH)
- …evaluating and responding to provider participation and pricing inquiries. + Analyze post-paid healthcare claims as it relates to pricing needs. + Apply in-depth ... communication, analytical, critical-thinking, and problem-solving skills. **Preferred Qualifications** + Claims processing experience. + Customer service experience.… more
- Elevance Health (Mason, OH)
- …+ Performs in-depth investigations on identified providers as warranted. + Examines claims for compliance with relevant billing and processing guidelines and ... prevention and control. + Review and conducts analysis of claims and medical records prior to payment. Researches new... and medical records prior to payment. Researches new healthcare -related questions as necessary to aid in investigations. +… more
- CVS Health (Columbus, OH)
- …based on current findings, regulations, and legislation, employing all tools associated with claims and appeals processing to mitigate risks. + Employs expert ... knowledge of the healthcare industry, both internally and externally, to address complaints...units on identified issues and potential risks related to claims and appeals. + Initiates frequent communication between constituents… more
- Cleveland Clinic (Cleveland, OH)
- …Preferred qualifications for the ideal future caregiver include: + Knowledge of healthcare operations + Claims experience - waystar, experian, availity, other ... you will work alongside passionate caregivers and provide patient-first healthcare . Cleveland Clinic is recognized as one of the...of new programs and strategic plans related to information processing , access and utilization. + Act as a consultant… more
- Humana (Columbus, OH)
- …to make an impact** **Required Qualifications** + 1 - 5 years or more of claims processing experience + Minimum of 1 year experience in conducting thorough root ... first** The Encounter Data Management Professional ensures data integrity for claims errors. The Encounter Data Management Professional work assignments are varied… more
- Humana (Columbus, OH)
- …of experience researching MS-DRG, APR-DRG and/or EAPG grouper logic + Experience processing or reviewing facility claims + Prior professional experience ... IT, the pricing software vendor, CIS BSS, Medicaid operations, claims operations, and other business teams involved in the...benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also… more
- Elevance Health (Mason, OH)
- …+ Experience with PBM/Plan insurance setup, including but not limited to the processing of claims adjudication and resolution of reject messaging strongly ... workflow in our contact center tool and our prescription processing system. + Partner and support pharmacists in the...dedicated to improving lives and communities - and making healthcare simpler. We are a Fortune 25 company with… more