- Henry Ford Health System (Troy, MI)
- …This includes but is not limited to: Coordinating timely and accurate claims submission for adjudication Coordinating and developing timely denial follow ... and identifying solutions to prevent denials. Oversee follow up to ensure all claims are resolved or responded to by the payers. Monitoring and adjusting workflow… more
- Robert Half Accountemps (Tampa, FL)
- …skills, combining compassion and attentiveness in interactions. * Familiarity with claims -related systems and processes, such as claim adjudication or ... home partners to expedite claim processing. * Investigate delays in insurance claims and provide solutions with a proactive and detail-oriented approach. * Build… more
- CVS Health (Carson City, NV)
- …and problems. **Additional Responsibilities:** Reviews pre-specified claims or claims that exceed specialist adjudication authority or processing expertise. ... day. **Position Summary** Reviews and adjudicates complex, sensitive, and/or specialized claims in accordance with plan processing guidelines. Acts as a subject… more
- AdventHealth (Maitland, FL)
- …methodologies + Applies significant understanding of medical coding systems affecting the adjudication of claims to include ICD-9/10, CPT, HCPCS II, DRG ... + 3 years Healthcare, Managed Care, Hospital or Ancillary claims analysis, Hospital or Ancillary claims payment, or related field with bachelors degree + 5… more
- Molina Healthcare (Salt Lake City, UT)
- …Partners to ensure resolution within 30 days of error issuance. * Evaluates the adjudication of claims using standard principles and state specific policies and ... clear and concise to ensure accuracy in auditing of critical information on claims ensuring adherence to business and system requirements of customers as it pertains… more
- University of Utah Health (Murray, UT)
- …+ Maintains accountability for customer service performance expectations. + Explains adjudication of claims for allocation of deductibles, co-pays, co-insurance ... to members, providers, billing departments and other insurance companies regarding claims , benefits and eligibility, provider network status, and any other related… more
- Astellas Pharma (South San Francisco, CA)
- …and private payers, their respective systems, processes, and key contacts involved in claims processing and adjudication . + Proven experience in working within ... and understanding the practice/reimbursement management environment in both offices and healthcare systems. + Effective communication skills, both verbal and written, including presentation skills + Strong Executive presence and experience engaging and… more
- AmeriHealth Caritas (Manchester, NH)
- …payment methodologies. + Drive implementation of electronic strategies to improve claims submission, auto- adjudication , and operational efficiency. + Ensure ... departmental compliance with Federal and State regulations, develop policies accordingly, and lead provider communication, education, and satisfaction initiatives. + Supervise, coach, and develop team members to achieve financial, quality, and clinical… more
- Dana-Farber Cancer Institute (Brookline, MA)
- …Bluebird Bio, and Gift of Life accounts to ensure accurate reimbursement and final adjudication of claims as needed. Works prebilling edits in the billing and ... scrubber systems to ensure timely submission of claims in accordance with department expectations. May also perform...the responsible parties in the billing system to ensure claims are addressed promptly. + Updates issues grid with… more
- Ascendis Pharma (Princeton, NJ)
- …. Investigate disputes, resolve variances, and assess duplicate discounts. . Lead adjudication of claims and validation processes; manage payments, purchase ... and meet deliverables of business operations to monitor, evaluate and administer claims to be paid and ensure payments are accurate, timely, formulary-compliant and… more