- Oracle (Austin, TX)
- …The consultant will configure business rules within OHI applications to facilitate claims adjudication , customizing rules to each payer's needs using programming ... translated into a working system within OHI applications, including Claims , Policies, Authorizations, Product Definition, and Oracle Insurance Gateway. Configuration… more
- InGenesis (Columbia, SC)
- …in data collection/input into system for clinical information flow and proper claims adjudication * Perform other duties as assigned. Minimum Qualifications ... criteria and assess and monitor medical necessity using your clinical proficiency and claims knowledge. This is a REMOTE opportunity for candidates living in the… more
- Banner Health (Greeley, CO)
- …degree in related field preferred. Proficiency and experience with third party claims adjudication and claims rejection reconciliation preferred. Proficiency ... and experience with non-sterile, sterile and hazardous drug compounding preferred. Work experience which demonstrates analytical ability, judgment and interpersonal skills in pharmacy or healthcare preferred. Experience and proficiency with computer software… more
- St. Luke's Health System (Boise, ID)
- …under the pharmacy benefits. + Facilitate resolutions to issues involving claims adjudication , member concerns, and provider communications. + Addresses ... and third-party issues such as prior authorization, step therapy, reviewing denied claims , and processing overrides. Works with an interdisciplinary team of pharmacy… more
- Excellus BlueCross BlueShield (Rochester, NY)
- …Medicaid, CPT, HCPCS, ICD10, DRG, APC, RBRVS, etc.). + Extensive experience with claims processing systems, claims flow, adjudication process, system edits ... in a clear and concise manner. + Analyzes proactive detection reports and claims data to identify red flags/aberrant billing patterns. + Manages cases as assigned,… more
- UnityPoint Health (Rock Island, IL)
- …of healthcare revenue cycle experience - understand healthcare financial terms, claims processing & adjudication , terminology. *Specific offers are determined ... policies - helping them to understand their financial liability and payer adjudication and cost sharing. + Record Keeping: Accurately document all customer… more
- UnityPoint Health (Sioux City, IA)
- …healthcare revenue cycle experience - understand healthcare financial terms, claims processing & adjudication , terminology. Knowledge/Skills/Abilities: + ... policies - helping them to understand their financial liability and payer adjudication and cost sharing. + Record Keeping: Accurately document all customer… more
- Billings Clinic (Billings, MT)
- …a neat and organized condition. * Processes complete prescription claims including proper adjudication /reconciliation, insurance verification, prior ... claims billing. * Enters medication charges and credits for the adjudication /reconciliation of patient accounts and insurance claims billing. * Participates… more
- Billings Clinic (Bozeman, MT)
- …a neat and organized condition. + Processes complete prescription claims including proper adjudication /reconciliation, insurance verification, prior ... claims billing. + Enters medication charges and credits for the adjudication /reconciliation of patient accounts and insurance claims billing. + Participates… more
- Humana (Frankfort, KY)
- …contracts, including contract language and reimbursement. + Comprehensive knowledge of claims systems, adjudication , submission processes, coding, and/or dispute ... issues with appropriate enterprise business teams, including those associated with claims payment, prior authorizations, and referrals, as well as appropriate… more