- Elevance Health (Norfolk, VA)
- …with external accreditation and regulatory requirements, internal policies and claims events requiring adaptation of written response in clear, understandable ... and analyze the grievance and appeal issue(s) and pertinent claims and medical records to either approve or summarize...submitted to hiring managers, are deemed to be the property of Elevance Health. Who We Are Elevance Health… more
- Elevance Health (Norfolk, VA)
- …and DRGs billed and reimbursed. Specializes in review of Diagnosis Related Group (DRG) paid claims . **How you will make an impact:** + Analyzes and audits claims ... Requires a minimum of 10 years of experience in claims auditing, quality assurance, or clinical documentation improvement, and...submitted to hiring managers, are deemed to be the property of Elevance Health. Who We Are Elevance Health… more
- Elevance Health (Norfolk, VA)
- …findings. + Health insurance experience required with understanding of health insurance policies, health insurance claims handling and provider network ... to recover corporate and client funds paid on fraudulent claims . **How you will make an impact:** + Claim...and minimum of 5 years related experience in healthcare insurance and healthcare insurance investigation, law enforcement;… more
- Elevance Health (Richmond, VA)
- … claims . Health insurance experience required with understanding of health insurance policies, health insurance claims handling and provider network ... and claim systems for review of facility, professional and pharmacy claims . + Responsible for independently identifying and developing enterprise-wide specific… more
- Elevance Health (Norfolk, VA)
- …I** is responsible for accurate and timely maintenance of provider information on claims and provider databases. **How You Will Make an Impact** Primary duties may ... to: + Assists in synchronization of data among multiple claims systems and application of business rules as they...submitted to hiring managers, are deemed to be the property of Elevance Health. Who We Are Elevance Health… more
- Elevance Health (Norfolk, VA)
- …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...submitted to hiring managers, are deemed to be the property of Elevance Health. Who We Are Elevance Health… more
- Elevance Health (Richmond, VA)
- …decisions. **How You Will Make An Impact:** + Analyze and monitor weekly incurred claims , paid claims , pharmacy, lab results, and authorizations to identify cost ... and actuarial software tools. + Experience working with large administrative claims datasets and healthcare cost/utilization metrics. + Ability to apply actuarial… more
- Elevance Health (Norfolk, VA)
- …Analyst I** is responsible for auditing and facilitating the recovery of claims overpayments as identified by our business partners. Responsible for research, ... **How you will make an Impact:** + Audits paid claims for overpayments using various techniques including systems-based queries,...submitted to hiring managers, are deemed to be the property of Elevance Health. Who We Are Elevance Health… more
- Elevance Health (Roanoke, VA)
- …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...submitted to hiring managers, are deemed to be the property of Elevance Health. Who We Are Elevance Health… more
- Elevance Health (Norfolk, VA)
- …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...submitted to hiring managers, are deemed to be the property of Elevance Health. Who We Are Elevance Health… more