- CDM Smith (Winston Salem, NC)
- …Assist the project team in developing and maintaining a project risk register. Claim management: Early support for claims and disputes on the project. ... Identify contractual requirements to maintain and prosecute claims , and assist project team in managing to those requirements. Ensure that proper documentation is… more
- Humana (Raleigh, NC)
- …of variable factors. Where you Come In Humana is looking for an experienced medical coding auditor to review inpatient hospital claims for proper reimbursement, ... part of our caring community and help us put health first** The Inpatient Medical Coding Auditor extracts clinical information from a variety of medical records… more
- Datavant (Raleigh, NC)
- …for healthcare. The Specialist is responsible for identifying, analyzing, and resolving claim denials across the entire revenue cycle to ensure optimal reimbursement ... throughout the entire revenue cycle, including registration, eligibility, coding, billing, and medical necessity. + Analyze denial trends and root causes using data… more
- BrightSpring Health Services (Raleigh, NC)
- …employment. This is not a remote position Benefits and perks for you! + Medical , Dental, Vision insurance + Health Savings & Flexible Spending Accounts (up to $5,000 ... calculations, including dosage and conversion tasks. + Investigate and resolve pharmacy claim denials; perform follow-up actions in POS systems. + Stay current with… more
- CVS Health (NC)
- …+ 1 year experience that includes both HMO and Traditional claim platforms, products, and benefits, patient management, product, compliance and regulatory ... service or audit experience. **Preferred Qualifications** + Medicare experience + Claims experience + Experience in reading or researching benefit language in… more
- CVS Health (Raleigh, NC)
- …monthly invoices in accounting system. + Enter and process monthly fee claims for ancillary product offerings via claim system. **Required Qualifications** ... to our competitive wages, our great benefits include: + **Affordable medical plan options,** a **401(k) plan** (including matching company contributions), and… more
- Otsuka America Pharmaceutical Inc. (Raleigh, NC)
- **Job Summary** Otsuka is looking for a strong Clinical Statistician in the Medical and Real World Data Analytics organization to provide statistical expertise for ... data scientists and data programmers, and external stakeholders including Medical Affairs, Value and Real World Evidence to provide...you will be reimbursed, this is not Otsuka. These claims are fraudulent and you are strongly advised to… more
- UNC Health Care (Durham, NC)
- …information into variety of systems 10. Research and determine if carrier denial of claim is valid. Abstract information from medical records to support appeal ... obtain authorizations and referral approvals for services and procedures. Research medical records to gather information and substantiate medical justification… more
- Allied Universal (Wake Forest, NC)
- **Company Overview:** Advance Your Career in Insurance Claims with Allied Universal(R) Compliance and Investigation Services. Allied Universal(R) Compliance and ... is the premier destination for a career in insurance claim investigation. As a global leader, we provide dynamic...We offer a comprehensive benefits package that may include medical , dental, and vision coverage, life insurance, a retirement… more
- CVS Health (NC)
- …insights and present findings to non-technical audiences. + 2+ years experience interpreting medical claim data + Advanced experience in SQL & Python coding ... analyses to support investigations of potential fraud, waste, and abuse in Medicaid claims and provider activity. + Prepare timely and accurate Medicaid regulatory &… more