- Elevance Health (Durham, NC)
- …fraud and abuse prevention and control. + Review and conducts analysis of claims and medical records prior to payment. Researches new healthcare-related ... Payment Integrity, is determined to recover, eliminate and prevent unnecessary medical -expense spending. The **Clinical Fraud Investigator II** is responsible for… more
- Humana (Raleigh, NC)
- …to make an impact** **Required Qualifications** + Minimum 1 year of experience in medical claims payment and processing + Minimum 1 year of experience analyzing ... and researching medical claims + Proficient in Microsoft Office (Word, Excel, Access, PowerPoint) + Working knowledge of SQL + Familiarity with EDI X12 formats… more
- CVS Health (Raleigh, NC)
- …for complaints and appeals received by the organization. This includes denied claims , coverage issues, medical necessity, service quality, or other concerns ... Excel, PowerPoint, Outlook). **Preferred Qualifications** + Prior experience working with claims . + Prior experience in health insurance. + Prior experience in… more
- Elevance Health (Winston Salem, NC)
- …**Coding Analyst Senior** is responsible for reviewing, auditing, and coding medical records for the purpose of reimbursement, training, education and compliance. ... you will make an impact:** + Audits and reviews medical documentation for appropriate ICD-9 and CPT coding and...unclear. + Trains and educates others on coding documentation, claim payment guidelines, and related issues. + Reviews CPT… more
- CVS Health (Raleigh, NC)
- …of this position include identifying specific provider network strategies to manage medical cost and trend. This is a unique opportunity to work directly ... organization (internal and external). - Must have strong knowledge of claim coding (CPT/DRG, etc.), provider networks, benefit designs, healthcare products/funding, … more
- Walgreens (Raleigh, NC)
- …pharmacist, including those to physicians. + Processes (corrects and resubmits) manual claims for third party program prescription services in a timely and efficient ... Maintains knowledge of Company asset protection techniques, and files claims for warehouse overages (merchandise received, but not billed), shortages… more
- Walgreens (Concord, NC)
- …the pharmacist, including those to physicians. Processes (corrects and resubmits) manual claims for third party program prescription services in a timely and ... Maintains knowledge of Company asset protection techniques, and files claims for warehouse overages (merchandise received, but not billed), shortages… more
- Walgreens (Asheville, NC)
- …pharmacist, including those to physicians. + Processes (corrects and resubmits) manual claims for third party program prescription services in a timely and efficient ... Maintains knowledge of Company asset protection techniques, and files claims for warehouse overages (merchandise received, but not billed), shortages… more
- Utilities Service, LLC (Charlotte, NC)
- …**Benefits:** + Company-sponsored Retirement Plan + Health Insurance ( Medical /Dental/Vision) + Employee Assistance Program + Life, long-term/short-term disability ... be delegated the authority to investigate incident reports, damage claims , etc., and to settle minor damage claims...to support our employees' health, well-being, and financial security. Medical , dental, and vision benefits are available to all… more
- Amentum (Raleigh, NC)
- …appropriate insurance coverage and risk mitigation strategies. + Lead complex claims management, including litigation strategy and resolution in coordination with ... defense sectors.** + Deep knowledge of insurance products, risk financing, claims management, and enterprise risk practices. + Strong negotiation, communication, and… more