- Exotic Automation & Supply (New Hudson, MI)
- …& Supplier Management + Maintenance and submission of customer rebates and subsidy claims to Suppliers + Input/Upload of Supplier Price Updates from price files + ... Coordinate and maintain Special Pricing Agreements from Suppliers System Integrity & Optimization + Continuously review and investigate all pricing overrides and work with Pricing and Sales Management on root cause analysis and resolution + Maintenance of… more
- Highmark Health (Lincoln, NE)
- …5 years with coding languages, analytical software, systems, tools and processes using claims , clinical, enrollment and provider data + 3 years of project leadership ... in a complex, matrixed environment (payer and/or provider preferred) + 3 years of providing analytical consultation to clinical, administrative, operational and financial stakeholders **Preferred** + Applied experience analyzing Social Determinants of Health… more
- SSM Health (St. Louis, MO)
- …leaders for proactive resolution of all property matters. Ensures all landlord default claims are resolved within cure period and documents are properly recorded. + ... Prepare transaction communication tools and packages for internal approval process. Provides support with documentation required to be used during the transaction management process, including new leases, renewals, purchases, sales, subleases, options, etc. +… more
- Centene Corporation (Jefferson City, MO)
- …+ Interprets and analyzes complex data from multiple sources including claims , provider, member, and encounters data. Proactively identifies and assesses the ... business impact of trends + Develops, executes, maintains, and troubleshoots complex scripts and reports developed using SQL, Microsoft Excel, or other analytics tools + Identifies and performs root-cause analysis of data irregularities and presents findings… more
- MVP Health Care (Rochester, NY)
- …other audit activities and manual reviews as requested, ensuring accuracy of claims and supporting overall payment accuracy. + Perform research using "best ... practices" in auditing methodologies, remaining current in CPC coding, reimbursement methodologies, MVP Policies and Procedures, and updates in professional literature. + Contribute to our humble pursuit of excellence by performing various responsibilities… more
- UPMC (Pittsburgh, PA)
- …and basic revenue cycle principles (documentation, coding, billing, authorizations, and claims processes) + Strong problem-solving and analytical skills, work across ... functions and communicate clearly with both clinical and non-clinical audiences. + Effective interpersonal communication skills; manage cooperation from stakeholders including providers, managers, and support staff. + Ability to work independently and… more
- MetLife (Clarks Summit, PA)
- …end dataflow and business applications such as Employee and Employer Benefits, Claims , Single Sign On setup, Annual enrollment processes, Employee profiles, Customer ... setup * Hands on experience in ServiceNow ticket management tool and dashboards. * Hands on experience in Core Java, SQL and Spring MVC, Spring BOOT, React frameworks. * Experience working in an Agile environment and has knowledge of Agile ceremonies. *… more
- Philadelphia Insurance Companies (Bala Cynwyd, PA)
- …the Philadelphia Insurance Companies, Tokio Marine America, Inc., TMNA Services, LLC, TM Claims Service, Inc. and First Insurance Company of Hawaii, Ltd.) is an ... Equal Opportunity Employer. In order to remain competitive we must attract, develop, motivate, and retain the most qualified employees regardless of age, color, race, religion, gender, disability, national or ethnic origin, family circumstances, life… more
- AnMed Health (Anderson, SC)
- …impact here. Summary Responsible for the resolution of disputes on escalated claims , utilization management, or other denials. Reviews any changes to health plans ... policy and procedures, recommending changes where appropriate. Maintains Managed Care contract inventory, reports, tracking grids and related processes. Responsibilities -Research Issues using EPIC, Health Plan Policies, guidelines & Tools, discussing with… more
- BronxCare Health System (Bronx, NY)
- …collection, analysis, implementation of and compliance with risk management and claims activities, support of and participation in Continuous Quality Improvement ... (CQI) teams, consistent adherence to the specific rules and regulations of the Bronx-Lebanon Hospital Center (a) Safety and Security Policies, (b) Risk Management: Incident and Occurrence Reporting, (c) Infection Control Policies and Procedures and (d) Patient… more
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