- Community Health Systems (La Follette, TN)
- …experience in understanding the minimum requirements needed for Medicare billing, medical claims processing, or hospital revenue cycle operations required + ... for performing timely and accurate Medicare billing activities, including claims preparation, eligibility verification, census validation, and documentation review.… more
- MAPFRE Insurance (Webster, MA)
- … and policy data. With the graph analytics, the relationship among the claim , the insured, their policy, previous fraudulent claims , are detected. Later, ... is also done in AWS using a Machine Learning Operations module. Once the models are deployed, these are...Claims team finally makes the decision about the claim . 2. A Policy Life Expectancy model, which predicts… more
- Ventura County (Ventura, CA)
- …(III, IV), performs and is responsible for billing and processing claims appropriately for timeliness in reimbursement and billing compliance with Medi-Cal, ... efficiency, and regulatory adherence in all mental health billing operations . Medical Billing Specialist III ( $ 25.10 -...health record (EHR) systems such as Cerner, HURON, and/or Claim Source to follow up on accounts. Medical Billing… more
- Saint Francis Health System (Tulsa, OK)
- …remittance processing using Epic Resolute Hospital Billing/Professional Billing (HB/PB) and associated claims tools (eg, Claim Edit Work Queues (WQs), Remittance ... all aspects of patient financial services including professional and hospital claims billing, cash posting, and management of patient receivables. This role… more
- CDM Smith (Raleigh, NC)
- …Smith is seeking a Forensic Accounting Specialist with expertise in disaster fraud claims . This role is critical in evaluating and analyzing financial data related ... to disaster-related claims , including property damage, business interruption, and other loss...potential fraud, and ensure the integrity and fairness of claim settlements. By applying advanced accounting, auditing, and investigative… more
- CVS Health (Austin, TX)
- …United States. In this role as Medical Director MPO (Medical Policy & Operations ) you will be responsible for providing clinical expertise and business direction in ... areas. Knowledge of Aetna clinical and coding policy and experience with appeals, claim review, reimbursement issues, and coding is preferable, but a willingness to… more
- Allied Universal (Arlington, TX)
- …platform to claim open shifts at client sites + Support operations across a range of environments including commercial real estate, healthcare, and education ... where flexibility meets opportunity. As a Part-Time Security Officer, you'll use our exclusive Claim a Shift platform to view and Pick up open shifts based on your… more
- Palo Alto Networks (Santa Clara, CA)
- …point of contact for transactional activities. The Channel Distribution Order Operations Specialist will primarily focus on processing orders, managing inventory ... related to order processing or fulfillment to Channel or Fulfillment Operations Management as needed. **II. Collaborative Planning, Forecasting, & Replenishment… more
- Towne Park (Nashville, TN)
- …the ability to positively move the metrics for forecasting, productivity, claims , customer service, and turnover + Manages scheduling, overtime for associates ... have been adequately trained in safety and loss prevention procedures + Ensures claims are reported timely and accurately and cooperates with the Risk Management… more
- Premera Blue Cross (Mountlake Terrace, WA)
- …CSS, CPMA) or equivalent. **Preferred Qualifications** + Knowledge of health plan operations and claim adjudication processes. + Experience with facility, ... Integrity office. This role is responsible for conducting pre-payment and post-payment claim audits to identify improper payments due to billing errors, coding… more
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