- AdventHealth (Apopka, FL)
- …needed + Trains new hires to the department on prescription data entry, claims adjudication and patient record management processes, offering ongoing support ... and adherence, prepares medications for pharmacist review/check, performs claim adjudication and processes customer (patient) account reconciliation. Facilitates prior… 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
- Catholic Health Services (Centereach, NY)
- …or similar EMR platforms Experience with retail pharmacy prescription processing and claims adjudication Prior experience on pharmacy dispensing systems and ... familiar with insurance adjudication processes This role involves working with a broad array of complex disease states and medical conditions. Candidates should be… more
- AdventHealth (Apopka, FL)
- …patient, drug, medication directions, refills and prescriber are selected + Processes claims adjudication and copay assistance billing for new prescription ... and adherence, prepares medications for pharmacist review/check, performs claim adjudication and processes customer (patient) account reconciliation. **The value… 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
- General Dynamics Information Technology (Fairfax, VA)
- …security). + Proficiency with healthcare management systems (provider enrollment systems, claims adjudication systems) and data analytics tools (Power BI, ... + Ensure all operations related to Member and Provider Enrollment, Credentialing, Claims Administration, and Payments are delivered in accordance with SLAs and QASP… 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 ... provides health management program interventions. Utilizes clinical proficiency and claims knowledge/analysis to assess, plan, implement, health coach, coordinate,… 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 ... provides health management program interventions. + Utilizes clinical proficiency, claims knowledge/analysis, and comprehensive knowledge of healthcare continuum to… more
- Dignity Health (Bakersfield, CA)
- …low-code tools. - Deep understanding of managed care operations and delegated functions ( claims adjudication , UM, provider data, etc.). - Demonstrated ability to ... deep familiarity with the complexities of delegated services, including claims , utilization management, provider data, and network operations. Essential Functions… more
- Beth Israel Lahey Health (Wakefield, MA)
- …including but not limited to:** + Understands the medical and pharmacy claims adjudication circle terminology, healthcare quality and EHR terminology and ... by data testing, the quality and accuracy of BILHPN's claims and EMR data. Responsible for developing reports for...in using Power BI or Tableau. + Knowledge of claims -based health care data, including medical terminology and standard… more