- Blue Cross and Blue Shield of Minnesota (Eagan, MN)
- …and reimbursement policies are implemented and integrated in all systems for accurate claims adjudication . This includes analysis of changes to medical code sets ... * Serve as a liaison to other divisions/departments (Health Management, Service, Claims ) for coding policy and coding/payment issues. * Directs and coordinates… more
- Humana (Springfield, IL)
- …limits. **Preferred Qualifications** + Bachelor's Degree. + Understanding of claims systems, adjudication , submission processes, coding, and/or dispute ... including, where necessary, collaboration with appropriate enterprise business teams (ex., claims payment, prior authorizations & referrals). + Work with internal… more
- Essentia Health (Superior, WI)
- …pharmacy technician experience + Previous experience working with patient medication profiles, claims adjudication and billing, copay assistance programs as well ... is a vital member of the pharmacy team and will assist in the adjudication , processing, packaging and distributive functions of the pharmacy working under the direct… more
- CVS Health (Hartford, CT)
- …+ 5+ years in commercial Aetna Claim Adjudication System (ACAS) contract testing, claims adjudication systems, or related functions. + 5 + years proven track ... record in governance, stakeholder management, and escalation handling. + 5 + years strong program and project management expertise, including integrated planning and risk management. Preferred Qualifications + Experience with commercial health programs,… more
- CVS Health (Hartford, CT)
- …pricing validation, or related functions. + 3 + years of strong understanding of claims adjudication systems and pricing methodologies. + 3 + years of ... over 300,000 purpose-driven professionals. We are seeking a **Manager - Aetna Claim Adjudication System (ACAS) Contract Pricing SME** to join our Testing Center of… more
- US Tech Solutions (Columbia, SC)
- …in data collection/input into system for clinical information flow and proper claims adjudication . + Demonstrates compliance with all applicable legislation and ... health management program interventions. + Utilizes clinical proficiency and claims knowledge/analysis to assess, plan, implement, health coach, coordinate, monitor,… more
- Omaha Children's Hospital (Omaha, NE)
- …regulations and medical terminology. This includes all aspects of payer relations, claims adjudication , contractual claims process and general reimbursement ... and daily management for insurance and government collections to include claims , A/R follow-up, denials and appeals. This includes supervising, monitoring, and… more
- Omaha Children's Hospital (Omaha, NE)
- …regulations and medical terminology. This includes all aspects of payer relations, claims adjudication , contractual claims process and general reimbursement ... and daily management for insurance and government collections to include claims , A/R follow-up, denials and appeals. This includes supervising, monitoring, and… more
- DATAMAXIS (Springfield, IL)
- …to make determinations relating to complex processes involving claims processing/ adjudication , recipient/provider eligibility, and third-party liability. ... projects like the following: CMS Federal Reporting, quality measures, claims processing, Medicaid program eligibility, provider enrollment, third-party liability. *… more
- Humana (Oklahoma City, OK)
- …providers (eg, provider relations, claims education) + Understanding of claims systems, adjudication , submission processes, coding, and/or dispute resolution ... issues with appropriate enterprise business teams, including those associated with claims payment, prior authorizations, and referrals, as well as appropriate… more