- 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 ... health management program interventions. + Utilizes clinical proficiency and claims knowledge/analysis to assess, plan, implement, health coach, coordinate, monitor,… more
- Omaha Children's Hospital (Omaha, NE)
- …regulations and medical terminology. This includes all aspects of payer relations, claims adjudication , contractual claims process and general reimbursement ... and daily management for insurance and government collections to include claims , A/R follow-up, denials and appeals. This includes supervising, monitoring, and… more
- Omaha Children's Hospital (Omaha, NE)
- …regulations and medical terminology. This includes all aspects of payer relations, claims adjudication , contractual claims process and general reimbursement ... and daily management for insurance and government collections to include claims , A/R follow-up, denials and appeals. This includes supervising, monitoring, and… more
- Humana (Oklahoma City, OK)
- …providers (eg, provider relations, claims education) + Understanding of claims systems, adjudication , submission processes, coding, and/or dispute resolution ... issues with appropriate enterprise business teams, including those associated with claims payment, prior authorizations, and referrals, as well as appropriate… more
- Robert Half Accountemps (Tampa, FL)
- … data management and editing within specialized systems. * Understanding of casualty claims and adjudication procedures. Robert Half is the world's first and ... extra follow-up tasks when required. Requirements * Previous experience in insurance, claims processing, or customer service is preferred. * Demonstrated ability to… more
- Banner Health (Gilbert, AZ)
- …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
- Aston Carter (Salem, OR)
- …improvement projects within a medical coding environment. + Understanding of EHR, Claims Adjudication Systems, Revenue Cycle concepts, and data mining tools. ... data manipulation and use of data analysis tools. + In-depth understanding of claims processing, clinical edits, fee schedules, and payer contracts. + Proficient in… more
- Northwell Health (New Hyde Park, NY)
- …(UM) criteria, and evidence-based drug therapy guidelines, and overseeing pharmacy benefit claims adjudication to match formulary intent. This role involves ... (PA, ST, QL) criteria development + Experience with benefit design, claims data analysis, and drug information interpretation. **Job Qualification** + Bachelor… more
- AmeriHealth Caritas (Columbia, SC)
- …Medicaid regulatory compliance;work experience preferred. + Knowledge and; proficiency in claims adjudication standards & procedures preferred. + Solid knowledge ... Proactively performs research using the Internet, data analysis tools, etc., to analyze aberrant; claims billing and practice patterns. + Analyzes data as part of the… more
- Fairview Health Services (Shoreview, MN)
- …opportunities. + Operational Oversight Oversee end-to-end PBM operations including claims adjudication , formulary management, rebate contracting, network ... (VP or above) + Expertise in PBM operations, managed care, pharmacy claims , rebate contracting, clinical programs, and regulatory compliance + Proven track record… more