- 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
- Elevance Health (Dearborn, MI)
- …provider communications regarding formulary changes. + Ensures appropriate formulary set-up and claims adjudication . + Serves as a clinical pharmacy resource to ... pharmacy benefit management and pharmacy operations teams. + Ensures compliance of the Medicaid formularies with state/federal mandates and contractual agreements. + Serves as a clinical resource to other pharmacists on areas such as prospective, inpatient,… more
- CVS Health (Indianapolis, IN)
- …skills (complex formulas, dynamic visualizations, VBA). + Experience with eligibility, claims adjudication , reserving, or financial reporting in the managed ... care industry. + Familiarity with Google Cloud Platform (GCP). + Background in health services research or epidemiology. **Education** Bachelor's degree in business, finance, public health, or a related field required. **Anticipated Weekly Hours** 40 **Time… 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
- Actalent (Irving, TX)
- …requests, eligibility verification, and generate refill documentation. + Process third-party claims adjudication accurately. + Read and interpret prescriptions ... accurately, verifying patient information and physician authorization. + Calculate correct dosage volumes and day supply, converting between metric and apothecary equivalents. + Ensure all orders are processed accurately within the required Service Level… 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