- UPMC (Bridgeville, PA)
- …via telephone, e-mail and face to face required. + Knowledge of electronic claims adjudication and resolution required + Experience with prioritizing and ... their dedicated team! This position provides prescription data entry and adjudication of claims under the supervision of a licensed pharmacist. This position… more
- State of Massachusetts (Boston, MA)
- …counseling, educational counseling, credit collection, credit interviewing, credit investigation, claims adjudication , claims settlement, claims ... this series make determinations on eligibility for benefits in disputed claims after gathering necessary information through interviews; issue timely determinations… more
- State of Massachusetts (Boston, MA)
- …counseling, educational counseling, credit collection, credit interviewing, credit investigation, claims adjudication , claims settlement, claims ... responsible for making determinations on eligibility for benefits in disputed claims after gathering necessary information through interviews; issue timely notices… more
- Providence (OR)
- …specialty societies, and assists with implementation of such changes to the claims adjudication and editing software. This position requires extensive knowledge ... will also be considered. + 2 years of experience with Facets Claims Adjudication system and/or Optum CES editing software. **Salary Range by Location:**… more
- Excellus BlueCross BlueShield (Rochester, NY)
- …degree or LPN with a minimum of two (2) years' experience in long term care claims adjudication and two (2) years long term care customer service. + Must have ... benefit file and claim payment to encourage timely submission and adjudication of claims within company and State time service standards. + Consistently… more
- NYU Rory Meyers College of Nursing (New York, NY)
- …standards. Perform compliance and monitoring assessments to identify exceptions to establish claims adjudication requirements for pre-EOB and after posting of ... in an Academic Dental Center, major dental group practice or Claims Adjudication area of an Insurance Carrier.Required Skills, Knowledge and Abilities:Effective… more
- Healthfirst (NY)
- …investigation, determination and reporting of financial processes** **_specifically around Healthcare Claims Adjudication and Claims Processing_** + ... + **Conduct moderately complex to complex quality audits of provider claims , pre-payments and post-payments including high-dollar and specialized claims … more
- State of Massachusetts (Boston, MA)
- …counseling, educational counseling, credit collection, credit interviewing, credit investigation, claims adjudication , claims settlement, claims ... benefit amounts, monetary eligibility, reviewing wages/earnings and issues on current claims to determine claimant eligibility on the new claim. Also responsible… more
- CVS Health (Hartford, CT)
- …of test plans and test results + 3+ years of HRP experience + Claims adjudication background + Knowledge of MedCompass and Utilization Management Configuration. ... into test scenarios to validate UM configuration and associated claim adjudication logic. + Trouble-shooting HRP repair edits and issues identified during… more
- Saint Francis Health System (Tulsa, OK)
- …oversight to maximize cash flow, reduce accounts receivable days, and ensure effective claims adjudication . This position plays a key role in monitoring ... all aspects of patient financial services including professional and hospital claims billing, cash posting, and management of patient receivables. This role… more