- Manulife (FL)
- …: + Successfully completes high-quality, sophisticated long term care claims investigations + Independently develops and drives a detailed investigative ... management and Requesters + Optimally applies internal case management systems to keep department management updated and to plan...and trains more junior investigators on long term care claim cases and processes + Ability to travel on… more
- Sharp HealthCare (San Diego, CA)
- …nursing facility admission including requests for outpatient care, retrospective claim review, medical equipment, medication issues and acquisition, home health ... HCPC coding using appropriate tools.Make determination on the more complex claims that are designated CC authorization level within SCMG TAT guidelines.Coordinates,… more
- Choctaw Nation of Oklahoma (Talihina, OK)
- …resources and explaining CRC determinations. 5. Review and enter referral and claim information into appropriate databases or systems to maintain accurate ... and federal requirements. You will support patients through scheduling, claims processing, eligibility review, denial communication, and appeals, while maintaining… more
- Elevance Health (Columbus, OH)
- …data mining, entity review, law enforcement referral, and use of proprietary data and claim systems for review of facility, professional and pharmacy claims . ... of healthcare fraud in order to recover corporate and client funds paid on fraudulent claims . **How you will make an impact:** + Claim reviews for appropriate… more
- Ankura (Miami, FL)
- …Assist in research and analysis project cost records and financial statements + Reconcile claim amounts to accounting systems and to insurers' calculations + Use ... Ankura's proprietary tools and industry standards in the development of claim methodology and work product + Develop computer models of schedules, contractor… more
- Boehringer Ingelheim (Ridgefield, CT)
- …accomplished by managing the Medicaid rebate operations for BIPI which includes claim processing, dispute resolution, quarterly CMS pricing compliance and systems ... are evaluated with the changing regulatory environment and are applied properly to claim payments. + Aggressively strive to settle all disputed rebate claims .… more
- National Nuclear Security Administration (Oak Ridge, TN)
- …oversight to ensure safety system operability, reliability, and availability of system systems and hazard controls are technically sound and the defensible ... Safety Analysis (DSA), and Technical Safety Requirements (TSR), Assigned Safety Systems , Cognizant System Engineer Program, and Configuration Management. Manage… more
- Fairview Health Services (St. Paul, MN)
- …processes. Provides subject matter expertise on technical and compliance areas that impact claims processing including EPIC HB system , and payor requirements. + ... in compliant and trusted outcomes for patients, providers, workforce and system . Overall responsibilities include development and oversight of operational metrics,… more
- University of Southern California (Arcadia, CA)
- …errors promptly and accurately. + Correct any errors promptly and have the claim resubmitted if needed. + Displays professional commitment and supports the unit team ... contractual adjustment on the account and have a corrected claim submitted to the insurance carrier in a timely...the patient account note area within the current computer system . + Maintain productivity report for accounts within assigned… more
- Aston Carter (Lombard, IL)
- …group rebate claims . + Create AP bill-backs in Blacksmith and review claims for proper disposition. + Investigate unauthorized claim amounts and ensure ... Blacksmith, and maintain all deductions in the Blacksmith Deduction Management system . Your role will involve collaboration with accounts receivable, customers,… more