- CVS Health (Springfield, IL)
- …analysis to estimate future healthcare costs, revenue, and profitability. + Analyzes claims data to assess patterns, trends, and cost drivers and identifies ... opportunities for cost containment, fraud detection, and quality improvement in claims processing and reimbursement. + Assesses impacts of new risk-sharing… more
- CVS Health (Augusta, ME)
- …Summary** **Position Summary** Responsible for initial review and triage of claims tasked for review. -Determines coverage, verifies eligibility, identifies and ... regarding confidentiality. -Assist in the research and resolution of claims payment issue **Required Qualifications** Effective communication, telephonic and… more
- Molina Healthcare (OH)
- …Experience working in a Medicare environment is highly preferred. + Claims adjudication experience is highly preferred. **Job Qualifications** **Required Education** ... encounter processes, provider and contract configuration, provider information management, claims processing and other related functions. **Preferred Education** Bachelor's… more
- UCLA Health (Los Angeles, CA)
- …compliance with government regulations, reimbursement issues, etc. + Analyze hospital billing claims within the EHR and claim scrubber system + Resolve claim errors, ... + Knowledge of Tableau Reporting dashboards + Understanding of Medicare/Medi-Cal claims processing guidelines + Experience with EPIC EHR, Cirius Claim Scrubber,… more
- Blue KC (Kansas City, MO)
- …Description Summary:** Serves as a Finance subject matter expert for the claims , billing and payment systems used by the company. Responsible for understanding, ... + Develops understanding of company's core operating systems used to process claims , capitation, premiums and other billing arrangements along with the supporting… more
- City of New York (New York, NY)
- …payments in compliance with financial policies and procedures. - Examine invoices, claims , fee collection or applications for recoupments, refunds and verify their ... revenue collection for outstanding balances. Investigate and research unidentified claims /payments received to determine its appropriateness to deposit the payments.… more
- CareFirst (Baltimore, MD)
- …setup of code sets used for configuration in benefits & pricing for claims processing, claims editing configuration set-up and maintenance. Analyzes business ... requirements and objectives towards determining the optimal configuration of the requirements. Creates complex design documents through the assessment of requirements. Assesses alternatives to different designs and chooses best solution to fit business needs.… more
- Centene Corporation (Richmond, VA)
- …database designs. + Interprets and analyzes data from multiple sources including claims , provider, member, and encounters data. Identifies and assesses the business ... impact of trends + Develops, executes, maintains, and troubleshoots moderately complex scripts and reports developed using SQL, Microsoft Excel, or other analytics tools + Identifies and performs root-cause analysis of data irregularities and presents findings… more
- Meijer (Grand Rapids, MI)
- …with guest to resolve difficult or unusual eCheck situations and Pharmacy claims . + Provide direct mentorship to Corporate Receivables team members and assists ... the Corporate Receivables Team Leader in training on all departments best practices. + Provide analytical support to Corporate Receivables Team Leader to ensure effective decision-making. + Conduct general ledger account analysis and prepare general ledger… more
- City of New York (New York, NY)
- …(PS) and Other Than Personnel Services (OTPS) expenses related to the reimbursement claims incurred in the DOTs expense budget. - Become proficient in the use ... of the City's Financial Management System (FMS) and the City Human Resource Management System (CHRMS), including MS suite such as Excel, Word, Access and PowerPoint. - Run reports related to FMS, FMIS and other citywide, state or federal applications. -… more