- St. Luke's University Health Network (Allentown, PA)
- …regardless of a patient's ability to pay for health care. The Denials Management Specialist reviews inpatient CMS and third party denials for medical necessity ... review. Provides billing with information needed to obtain payment of claims . Remote within local geography after orientation. JOB DUTIES AND RESPONSIBILITIES:… more
- AscellaHealth (Berwyn, PA)
- What we are looking for Optime Care seeks a Prior Authorization and Appeals Specialist for our Berwyn, PA location. We are looking for someone who is passionate ... reconsideration, both written and verbal. + Overcome objections that prevent payment of claims and gain commitment for payment through a concise and effective appeal… more
- Guardian Life (Bethlehem, PA)
- …Overview:** We are seeking a highly skilled and proactive **Data Management Operations Specialist ** to join our Data Management team in the insurance industry. This ... are a plus. + Knowledge of insurance-specific data structures (eg, policy, claims , underwriting data) is an advantage. **Desired Attributes:** + Highly organized… more
- UPMC (Pittsburgh, PA)
- UPMC Community Medicine Incorporated is hiring a full-time Contact Center Specialist to support Groff Orthopaedics - UPMC located at 510 S. Aiken Avenue Suite EG EG ... through Friday 8am to 5pm. The ideal candidate will have previous medical office experience. **Responsibilities:** + Answer multi-line telephone system, with a clear… more
- Guardian Life (Bethlehem, PA)
- …seeking a resolute motivated individual to join our team as a Benefits Operations Specialist . This role is responsible for serving as a subject matter expert on ... key resource for day-to-day tier 3 escalations related to eligibility, enrollment, and claims . This includes but is not limited to: + Overseeing the Field… more
- Deloitte (Pittsburgh, PA)
- …and business terms) with PBMS + Experience performing analytical analysis of medical & pharmacy claims , including understanding financial impact of network ... emerging trends and cost drivers + Work directly with medical and PBM vendors to analyze the program offering...in rate negotiation, and analyzing financial terms for both medical and pharmacy + Prepare financial projections and rate… more
- Intermountain Health (Harrisburg, PA)
- …Classification of Diseases ICD-10 and Diagnosis Related Groups (DRG) codes for claims concurrently while a patient is in a hospital. It ensures accurate ... coding in an inpatient hospital setting. AND Demonstrated understanding of medical terminology, medical acronyms, anatomy and physiology. AND Demonstrated… more
- Highmark Health (Harrisburg, PA)
- …or required. **QUALIFICATIONS:** Minimum + 2 years experience in a physician medical practice with a basic understanding of various payer billing requirements and ... claims processing or experience with payer credentialing/enrollment requirements +...Certified Provider Credentialing Support (CPCS) by the National Association Medical Staff Services + Experience with ECHO and/or professional… more
- Aston Carter (Canonsburg, PA)
- …market enhancement. + Provide assistance to the legal department to resolve claims and civil matters. + Perform other Land Department responsibilities as assigned. ... the benefits available for this temporary role may include the following: * Medical , dental & vision * Critical Illness, Accident, and Hospital * 401(k) Retirement… more
- MetLife (Clarks Summit, PA)
- …analyze and render appropriate claim decisions on STD, PML and state claims . Clarify functional capacity through independent problem-solving measures and discretion ... (gathering medical , vocational, and other information, efficient use of resources, and action planning) sufficient to determine initial and ongoing liability. .… more