- PedIM Healthcare (Crystal River, FL)
- …Supportive and collaborative work environment. Responsibilities: Review and process medical claims for accuracy and completeness. Verify patient billing data and ... resolve any discrepancies. Generate and submit insurance claims to payers promptly. Follow up on unpaid or denied claims and handle appeals as needed. Work with… more
- UMB Bank (Kansas City, MO)
- …various UMB clients and internal partners to escalate, investigate, and resolve fraud claims multi payments channels and mitigate risks for our customers and for ... financial knowledge, the Fraud Enterprise Operations team consists of 3 teams; Prevention, Claims and Data Strategy that all focus on what's best for our customers… more
- Oracle (Boston, MA)
- …grow your career in this exciting arena. We are looking for a Senior Claims Denial Prevention and Appeals Specialist for providing clinical inputs to engineering for ... clinical validation) to lead the appeals initiative to review denied claims , create write-ups for appeals packets, identify trends/improvement opportunities to… more
- Humana (Boston, MA)
- …caring community and help us put health first Own and manage Medicaid claims analytics dataset using Databricks. Ensure data accuracy, completeness, and readiness to ... data transformations, automation, and enhancements. Conduct in-depth analysis of healthcare claims to identify data issues and optimization opportunities. Work with… more
- UnitedHealth Group (Minnetonka, MN)
- …Guidelines, and AHA Coding Clinic Guidelines in the auditing of inpatient claims . Employing both industry and Optum proprietary tools, you will validate ICD-10 ... accurately to make audit determinations, generate audit rationales and move claims through workflow process correctly Demonstrate knowledge of and compliance with… more
- Humana (Lansing, MI)
- …an impact Required Qualifications Bachelors Degree Minimum of 3 years of medical claims auditing experience (interpreting if claims initially paid correctly in ... Payment Integrity (formally known as Financial Recovery) experience CAS claims knowledge Prior vendor relationship experience/knowledge Intermediate knowledge with… more
- Humana (Raleigh, NC)
- …CFOs, clinical teams, and provider engagement teams, focusing on Medicaid claims and premium analytics across multiple states, including established and expansion ... data connecting financial outcomes with operational results, particularly in Medicaid claims and premiums. Deliver project-based and ad-hoc reporting for Medicaid… more
- Walmart (St. Helens, OR)
- …facility level training and execution of asset protection safety functions and claims and receiving procedures by reviewing the application of policies procedures ... training needs and developing and delivering the training where needed Manages claims and receiving operations by ensuring proper policies and procedures are… more
- Otsuka America Pharmaceutical Inc. (Oklahoma City, OK)
- …and external regulations. This position reports directly to the Associate Director, CNS Scientific Communications. Job Description Key Responsibilities Include: ... Core Content Development Under the guidance of the Associate Director, Medical Communications, draft and maintain high-priority, foundational...you will be reimbursed, this is not Otsuka. These claims are fraudulent and you are strongly advised to… more
- Humana (Salem, OR)
- …encompasses critical functions including care coordination, quality measurement, billing, claims processing, and customer service, each essential to delivering a ... knowledge of core functional areas (care coordination, quality, billing, claims , and customer service). Collaborate with each Insurance Operations function… more
