- NHS Management, LLC (Northport, AL)
- …adjudicated prescriptions leaving the pharmacy have received a paid response or the claim has been resolved to bill to the next appropriate payor. Performs and/or ... PA's associated with all adjudicated Medicaid, Medicare D or Private Insurance claims . + Serves as the Communication liaison regarding medication or resident… more
- CVS Health (Frankfort, KY)
- …experience. ** Preferred Qualifications** -Experience in research and analysis of claim processing a plus. **Education** -Some college preferred . -High School ... to the member to determine accuracy/appropriateness of benefit/administrative denial. -Research claim processing logic to verify accuracy of claim payment,… more
- Cardinal Health (Trenton, NJ)
- …to patient care + Consults with appeals department for disputed / denied claims . + Works / Understands electronic claim interchange + Understands life ... cycle of primary and secondary claims + Maintains front office support relationship + Takes...+ Minimum 2 years of experience in Insurance follow-up preferred + Understanding of managed care contracts and fee… more
- HUB International (Nashville, TN)
- …experience and in-depth knowledge of insurance markets, policy provisions, claim processes, business environment, and risk mitigation, applies independent and ... responsible. These include non-routine coverage issues and questions, denial of claims , renewal strategies for key accounts, and interpretation of non-routine… more
- Walmart (Bentonville, AR)
- …space. This is a heavily matrixed environment with daily interactions with Claims , Legal, Finance, and Controllership functions. **What you'll do** : + Analyze ... and interpret complex data to inform business decisions, including loss ratios, claim frequencies, and severity of losses + Develop tactical and executive-level… more
- Henry Ford Health System (Troy, MI)
- …This includes but is not limited to: Coordinating timely and accurate claims submission for adjudication Coordinating and developing timely denial follow up ... to prevent denials. Oversee follow up to ensure all claims are resolved or responded to by the payers....Monitors and maintains acceptable work queue volumes ,for DNB's, Claim edits, Denials and follow up EDUCATION AND EXPERIENCE:… more
- Medical Mutual of Ohio (OH)
- …This is a fully remote opportunity. Eastern Time Zones preferred .** **Responsibilities** **HEDIS Analyst II** + Coordinates and collaborates interdepartmentally ... utilize certified HEDIS software. + Ability to analyze clinical, claims , pharmacy, encounter, and quality measurement data. + Advanced...related field + Master's degree (MBA, MPH, or MHA) preferred + 5 years progressive experience as a HEDIS… more
- Ramsey County (St. Paul, MN)
- …clients who do not meet ongoing eligibility criteria. + Review vendor payment claims for accuracy, check claim amounts against established fee schedules, ... cases and monitoring case activities, reviewing and processing vendor payment claims , maintaining necessary files and records; informing trial witnesses when needed… more
- UPMC (Pittsburgh, PA)
- …excellence, our Member Services Team educates and guides our members through coverage, claims , and other program inquiries. UPMC Health Plan is proud to be an ... comprehensive on-the-job training program. In-office opportunities are available if preferred . What a Health Care Customer Service, Associate does:...clearly and simply, like how to check on a claim or what a benefit includes._ + _Solve problems… more
- PeaceHealth (Vancouver, WA)
- …clinical risk management risk investigations and response to events, potential claims , and grievances presented against caregivers, physicians and the organization ... for potential or actual liability and damages. Collaborating with Claims , collects documents and evidence and maintains work product in accordance with state legal… more