- Rady Children's Hospital San Diego (San Diego, CA)
- …accurate adjudication of claim for reimbursement. They will process claims correctly following contractual arrangements the Medical Practice Foundation (MPF) has ... payors, including but not limited to; Commercial, Medi-Cal and Managed Care professional claims . This position is responsible checking status of unpaid claims by… more
- Emory Healthcare/Emory University (Atlanta, GA)
- …card distribution, accurate provider directories, performance on VBC contracts, benefit adjudication , appeals, and grievances. + Collaborate with the TPA to ... with providers, negotiate contracts (where necessary), and ensure quality of care. CLAIMS MANAGEMENT: + Oversee TPA claim processing, ensure accurate and timely… more
- University of Virginia (Charlottesville, VA)
- …correct reimbursements from insurance companies. They are responsible of ensuring all claims billed are in compliance with all federal and state requirements and ... as the liaison between insurance companies, patients and the departments to ensure the claims are processed and followed up to meet the CBO Revenue Cycle performance… more
- Insight Global (Dayton, OH)
- …area of responsibility. Within their day to day, they will be participating in claims data processes to ensure accuracy and compliance with state agencies. We are a ... Skills and Requirements 2+ years of experience in managed healthcare, claims , or managed care 2+ years of experience with SQL, SAS,… more
- Actalent (Cary, NC)
- …patient profiles by processing eligibility checks and adjudicating pharmacy claims . You will communicate with providers regarding medication prior authorizations ... therapy plans. Responsibilities + Process eligibility checks and adjudicate pharmacy claims . + Troubleshoot claim rejections and communicate correct information to… more
- UIC Government Services and the Bowhead Family of Companies (Springfield, VA)
- …Assistants to support our customer on the TSA Personnel Security Adjudication (PERSEC) Services contract. **Responsibilities** * Maintain proficiency in the business ... and other protected characteristics EOE/D/V. In furtherance, pursuant to The Alaska Native Claims Settlement Act 43 USC Sec. 1601 et seq., and federal contractual… more
- Adecco US, Inc. (Irving, TX)
- …focused on supporting specific drug (including Benefit Investigation, Prior Authorization, Claims Assistance, and Appeals) and educating the office on Payer ... high-impact reimbursement cases by overseeing benefit investigations, prior authorizations, claims escalations, and appeals, ensuring timely patient access. 3.… more
- MyFlorida (Jacksonville, FL)
- …perform support duties relating to the processing of Social Security disability claims . This position requires the incumbent have good oral and written communication ... to associate medical, functional, and/or vocational evidence with pending disability claims . Once identified by case, uploads documents. Responsible for uploading… more
- Actalent (Cary, NC)
- …on patient profiles by processing eligibility checks and adjudicating pharmacy claims . + Adjudicate claims and troubleshoot rejections, ensuring correct ... and financial support options. + Serve as a technical resource for adjudication while identifying areas for improvement. + Enter detailed, accurate, and… more
- Highmark Health (Dover, DE)
- …medication requests, and drug claim edits/prior authorizations. By reviewing member claims history, clearly defines the medical necessity of non-formulary and prior ... Enter all authorizations into the Argus IPNS information system to allow claim adjudication . + Complete other assigned duties as specified. + Identify and report… more