- Molina Healthcare (Augusta, GA)
- …of pharmacy prior authorization requests and/or appeals. * Explains point-of-sale claims adjudication , state, NCQA and CMS policies/guidelines, and any ... other necessary information to providers, members and pharmacies. * Assists with clerical tasks and other day-to-day pharmacy call center operations as delegated. * Effectively communicates plan benefit information, including but not limited to: formulary… more
- 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 (Montpelier, VT)
- …oversight to the provider set-up and contract configuration to ensure accurate claims adjudication + Evaluate and monitor providers' performance standards and ... financial performance of contracts. + Assist with and track credentialing activities + Facilitate the organization of provider focus groups + Coordinate with internal departments and contracted providers to implement and maintain contract compliance + May… more
- State of Massachusetts (Holyoke, MA)
- …professional or paraprofessional 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 the required experience on the basis of two years of education for one year… more
- Centene Corporation (Carson City, NV)
- …opportunities + Oversee provider set-up and contract configuration to ensure accurate claims adjudication and facilitate the organization of provider focus ... groups + Evaluate and monitor providers' performance standards and financial performance of contracts + Ensures compliance with national contracting standards, reimbursement standards, provider set-up rules, exception process and use of model contract language… more
- Veterans Affairs, Veterans Health Administration (Fayetteville, AR)
- …disability examinations, as requested by VBA, in support of disability claims adjudication . Completes C&P disability examinations, following established ... process/procedure as outlined in the Veterans Health Administration (VHA) office of Disability and Medical Assessment (DMA) Compensation and Pension (C&P) Disability examinations Procedure Manual. Maintains all mandatory training specific to operation as aC&P… 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
- Arkansas Children's (Little Rock, AR)
- …required attachments before being filed to payer (clean claim). 2. Expedites proper adjudication of claims by payer to maximize reimbursement and minimize older ... not being adjudicated and how we might overcome lack of adjudication . 3. Reviews adjudicated claims to assure they were properly adjudicated with the proper… more
- Robert Half Finance & Accounting (Winston Salem, NC)
- … claims or customer service. * Strong understanding of healthcare claims processing, including Medicare supplements and adjudication . * Demonstrated ability ... Description We are looking for a Medical Claims Supervisor to lead a dynamic team in...a skilled leader with a strong background in healthcare claims and a commitment to driving performance while maintaining… more
- Dignity Health (Bakersfield, CA)
- …advanced-level role responsible for the detailed and accurate processing, review, and adjudication of complex healthcare claims . This position requires expert ... claims processing, coding, and regulatory compliance. The Claims Examiner III will handle the most challenging cases,...**Minimum Qualifications:** + 3-5 years of experience in healthcare claims processing, with at least 2 years in a… more