- Beth Israel Lahey Health (Boston, MA)
- …Pharmacy. 4. Knowledge of prior-authorization workflows, payer relations, prescription claims adjudication , and general reimbursement procedures. 5. Ability ... to develop strong relationships with diverse groups of professionals (physicians, nurses, administration, etc. 6. Experience with computer systems required, including web based applications and some Microsoft Office applications which may include Outlook,… more
- Centene Corporation (Harrisburg, PA)
- …and oversee to the provider set-up and contract configuration to ensure accurate claims adjudication + Initiate contact and identify potential providers by ... geographic and specialty needs and update database + Coordinate with internal departments and contracted providers to implement and maintain contract compliance **Education/Experience:** Bachelor's degree in Healthcare Administration, Business Administration,… more
- State of Massachusetts (Boston, MA)
- …part-time, professional experience in social work or social casework, claims adjudication , job placement, recruitment, employment counseling, vocational ... or rehabilitation counseling, credit investigation, educational counseling, legal advocacy, or legal counseling. SUBSTITUTIONS: - A Bachelor's or higher degree may be substituted for two years of the required experience on the basis of two years of education… more
- CDPHP (Latham, NY)
- …health information required. + Chronic Conditions knowledge preferred. + Experience in claims adjudication , billing and enrollment systems, product or pricing is ... preferred. + Experience with Microsoft Office, including Word, Excel, Outlook and PowerPoint is required. + Experience with Clinical Documentation Improvement preferred. + Demonstrated knowledge of medical record review and diagnosis coding within the health… more
- KPH Healthcare Services, Inc. (East Syracuse, NY)
- …direct compliance issues to appropriate resources for investigation and resolution of claims adjudication issues. + Ensures that activities are conducted ... according to the policies and procedures of HealthDirect. + Supports HIPAA compliance efforts to ensure policies and procedures are appropriate to meet HIPAA requirements and identifying operational obstacles to compliance and working with other employees to… more
- Centene Corporation (Montgomery, AL)
- …and oversee to the provider set-up and contract configuration to ensure accurate claims adjudication + Initiate contact and identify potential providers by ... geographic and specialty needs and update database + Coordinate with internal departments and contracted providers to implement and maintain contract compliance + Performs other duties as assigned + Complies with all policies and standards… more
- State of Montana (Helena, MT)
- …(RMTD) provides comprehensive and cost-effective risk management programs, insurance coverage, claims adjudication services, and legal defense to state agencies ... and universities that serve the citizens of Montana. We are seeking a*Property/Casualty Insurance Program Manager*who will oversee all 30 property/casualty insurance programs and renewals each fiscal year and who will report to the RMTD Administrator/Chief… more
- Centene Corporation (New York, NY)
- …DRG, HCPC reimbursement methodologies. + Documents rate negotiation accurately for proper claims adjudication . + Acts as liaison between the TRICARE beneficiary ... and the provider, facility and the MTF to utilize appropriate and cost effective medical resources within the direct care and purchased care system. + Identifies and refers potential cases to Disease Management, Case Management, Demand Management and… more
- Allied Solutions (Plano, TX)
- …Losses ; refer timely and accurately to more senior level adjusting staff for adjudication and collection; + Adjudicate claims within the guidelines of the ... Position Summary; This position is responsible for the initial setup and investigation of claims prior to the assignment of the claim to a licensed adjuster. This… more
- Insight Global (Norcross, GA)
- … Adjusters to join their team.. As an adjuster you will be responsible for adjudication of mechanical repair claims , tire claims and pre-paid maintenance ... adjuster will report to the Senior Director of Claims Operations and Field Support and functions as a...customer service and customer satisfaction. The positions require the claims adjusters be adept at utilizing a computer database,… more