- Excellus BlueCross BlueShield (Rochester, NY)
- …documentation and communication with Insured, Insured's family, care providers, and monitoring of claim submission and processing . All work is directed under the ... of services as is deemed necessary. + Evaluates submitted claims to determine if services billed and provided are...insurance contract. + Reviews the Insured's benefit file and claim payment to encourage timely submission and adjudication of… more
- Waystar (Atlanta, GA)
- …We process billions of transactions annually, leveraging a massive dataset of claims , remittances, and patient data to drive outcomes. With Waystar AltitudeAI (TM) ... using LLMs for policy document interpretation, predictive modeling for claim denial rates, intelligent task prioritization) to create differentiated, proprietary… more
- Excellus BlueCross BlueShield (Rochester, NY)
- …. Ensures accurate payment by independently utilizing DRG grouper, encoder, and claims processing platform. . Manages case volumes and review/audit schedules, ... business analysis. . Intermediate knowledge of PC, software, auditing tools and claims processing systems. Level II (in addition to Level I Qualifications) .… more
- FLACRA (Newark, NY)
- …FLACRA's billing and payment collection processes. This position is responsible for processing claims , managing accounts receivable, and ensuring timely and ... up on outstanding balances. + Work with insurance companies to address disputed claims and resolve processing issues. + Maintain and update tracking spreadsheets… more
- Lithia & Driveway (Mesquite, TX)
- …occur. + Check each repair order against the vehicles' service history to avoid processing duplicate claims or submitting claims forshop comebacks. + Review ... and process all returned/rejected/adjusted warranty claims , track each claim until its final resolution. + Contact the appropriate warranty claims … more
- Louisiana Department of State Civil Service (Baton Rouge, LA)
- …systems and policy. + Minimum 2 years professional experience with liability insurance claims processing . + Minimum 1 year professional experience with CPT, ... advanced working knowledge of Medicaid and Eligibility policy to interpret Medicaid claims . + Participates in the development and implementation of TPL policies and… more
- Louisiana Department of State Civil Service (Baton Rouge, LA)
- …Medicaid systems and policy. *Minimum one year of experience with liability insurance claims processing . *CPT, ICD-9 or ICD-10 coding, and HCPCS knowledge. ... advanced working knowledge of Medicaid and Eligibility policy to interpret Medicaid claims . *Participates in the development and implementation of TPL policies and… more
- CVS Health (Boise, ID)
- …review a clinical determination and understand rationale for decision. + Able to research claim processing logic and various systems to verify accuracy of ... benefit language in SPDs or COCs. + Experience in research and analysis of claim processing a plus. + Demonstrated ability to handle multiple assignments… more
- Hartford HealthCare (Farmington, CT)
- …in order to resolve edits, denials or exceptions detected during system processing of the claim . *_Position Responsibilities:_* 1. Analyze and resolve ... staff that has certified coders to correct and resolve claim and denial issues. In addition, the department includes...billing expertise with some clinical knowledge that are delaying claims from processing in the Patient Accounting… more
- Commonwealth of Pennsylvania (PA)
- …questions, you must attach a copy of your college transcripts for your claim to be accepted toward meeting the minimum requirements. Unofficial transcripts are ... position. Failure to provide complete and accurate information may delay the processing of your application or result in a lower-than-deserved score or… more