- LA Care Health Plan (Los Angeles, CA)
- …incentives or any additional service needs according to specific program guidelines. Uses claims processing and care management software to look up member ... stratification, predictive modeling, provider's utilization review vendors, members, Call Center, claims staff, Health Homes Program (HHP) eligibility or other data… more
- University of Michigan (Ann Arbor, MI)
- …Clinics** + Ensure CMDS Clinic and provider NPIs are correctly added in CHAMPS for claims processing . + Work with hospital billers to address denied or duplicate ... inquiries. + Obtain post-service authorizations and assist with appeals for denied claims . + Attend Revenue Cycle Forum meetings and communicate updates to… more
- HTC Global Services Inc (Troy, MI)
- …PL/SQL) Experience and Skills: + 1-5 years of JAVA development experience. + 837 claims processing domain knowledge. + Good understanding of Database design and ... Work experience in HIPAA Compliant Java libraries to process 837 claims . + Familiar with claims processing terms such as Trading Partner Management… more
- Walmart (Augusta, GA)
- …resolves problems in the prescription fulfillment process when necessary by processing information for third-party insurance claims rescanning illegible images ... and procedures by assisting the pharmacist in the prescription fulfillment process processing third party insurance claims and/or rejections assisting patients… more
- ManpowerGroup (Joplin, MO)
- …you will be part of the Office support team, assisting with medical claims processing and customer service. The ideal candidate will demonstrate professionalism, ... + Learn to review, analyze, and process medical insurance claims in accordance with company policies and regulatory guidelines...very nice to have skill + Proficiency in Word Processing , Spreadsheets, and 10-Key data entry + Excellent telephone… more
- Sedgwick (Orlando, FL)
- …applications and data flow between external systems via API/SFTP, middleware processing servers and Salesforce. Salesforce Maps, Salesforce Field Service Lightning, ... Gain deep familiarity with key application modules, including reports, parameters, claims management, intake services, IIS Servers, SQL Servers and Salesforce… more
- BlueCross BlueShield of North Carolina (NC)
- …use of site visits to inform provider service strategy and resolve escalated claims and service issues + Oversee support of non-platinum providers through virtual ... ensuring that provider service agreements are met + Report operational updates to the Claims AVP and Operations VP; serve as a subject matter expert for provider… more
- Molina Healthcare (Pensacola, FL)
- …billing, or equivalent combination of relevant education and experience. * Claims processing experience, including coordination of benefits, subrogation, and/or ... and timely validation and maintenance of critical provider information on all claims and provider databases, and ensures adherence to business and system… more
- Humana (Oklahoma City, OK)
- …best outcomes; work closely with internal and external auditors, financial investigators, and claims processing areas + Assist in developing FWA education to ... (Clinical Certifications, CPC, CCS, CFE, AHFI) + Understanding of healthcare industry, claims processing and investigative process development + Experience in a… more
- Health Care Service Corporation (Oklahoma City, OK)
- …+ Understanding of health care contracts, applications and products. + Working knowledge of claims processing systems. + 3 years experience utilizing a PC. + ... of health care contracts, applications and products. + Working knowledge of claims processing systems. **Are you being referred to one of our roles? If… more