- Molina Healthcare (Green Bay, WI)
- …combination of education and experience **PREFERRED EXPERIENCE:** 3+ years healthcare Medical claims auditing **PHYSICAL DEMANDS:** Working environment is ... clear and concise to ensure accuracy in auditing of critical information on claims ensuring adherence to business and system requirements of customers as it pertains… more
- TEKsystems (Delavan, WI)
- About the Role We are seeking a detail-oriented and customer-focused Claims Resolution Specialist to join our team. This role is responsible for managing and ... resolving claims submitted by customers, transportation, and credit departments. Using...customer satisfaction with company interests, ensuring timely and accurate resolution of issues while supporting healthy accounts receivable aging.… more
- Molina Healthcare (Green Bay, WI)
- …Summary** Responsible for reviewing and resolving Medicare member appeals and Medicare claims in communicating resolution to members and provider (or authorized ... and Medicaid **KNOWLEDGE/SKILLS/ABILITIES** + Responsible for the comprehensive research and resolution of the appeals from Molina members, providers and related… more
- Molina Healthcare (WI)
- …for reviewing and resolving member and provider complaints and communicating resolution to members and provider (or authorized representatives) in accordance with ... Medicaid **KNOWLEDGE/SKILLS/ABILITIES** + Responsible for the comprehensive research and resolution of the appeals, dispute, grievances, and/or complaints from… more
- Molina Healthcare (Green Bay, WI)
- …and timely validation and maintenance of critical provider information on all claims and provider databases (using SQL, Excel, and QNXT). Staff ensure adherence ... areas of responsibility (eg, Provider Services/Provider Inquiry Research & Resolution , Provider Contracting/Provider Relationship Management). + Provides timely, accurate… more
- Elevance Health (Waukesha, WI)
- …an accommodation is granted as required by law._ The **Patient Enrollment Specialist Team Lead** is responsible for providing technical direction, guidance, and ... resources to claims , customer service, or membership associates on a day-to-day...ensure workflow remains uninterrupted; handles complex case research and resolution ; reviews, interprets and maintains records of service level,… more
- Cognizant (Madison, WI)
- …to the Health Plan/Payer. The comprehensive process includes analyzing, reviewing, and processing medical necessity denials for resolution . You will be a valued ... accounts. . Maintain working knowledge of applicable health insurers' internal claims , appeals, and retro-authorization as well as timely filing deadlines and… more
- Festival Foods (WI)
- …and plans to meet department objectives. Provides direct leadership to the Senior Claims Specialist and Workplace Safety Specialist . Prepares and delivers ... settling motions, pretrial filings and conferences. + Oversee and review vocational reports and medical record reports related to various claims lines. + Act as… more
- Elevance Health (La Crosse, WI)
- …current provider network through customer service including training, credentialing assistance, claims resolution and advocacy. Develops and provides a standard ... **How you will make an impact:** + Provides/coordinates provider training for claims and billing procedures, contract compliance, medical management, and… more
- Highmark Health (Madison, WI)
- …relationships hold the key to uncovering society's most complex challenges? Do you see medical records not just as disparate facts, but as a vast, dynamic network of ... work will directly impact millions of lives. As our Lead Graph Intelligence specialist , you will be the spearhead of cutting-edge research projects. This means… more