- New York State Civil Service (Melville, NY)
- …only Case Manager in the NYS Segment.* Work-up and process Workers' Compensation claims .* Approve and deny medical bills.* Respond to claimant and provider inquiries ... via phone and email.* Routinely communicate with employers to obtain info about claims .* File forms and correspond with the Workers' Compensation Board.* Review … more
- Florida Crystals Corporation (Baltimore, MD)
- …programs + The prevention of accidents through incident investigations, site assessments, associate communication and data analysis + Define plant safety goals to ... Party Administrator (TPA), to review and monitor workers' compensation claims costs and develop plans to minimize active ...claims costs and develop plans to minimize active claims . WORK EXPERIENCES + Minimum of five years of… more
- Humana (Oklahoma City, OK)
- …investigations into allegations of fraud, waste, and abuse involving providers who submit claims to Humana's Oklahoma Medicaid line of business. As the Senior Fraud ... outcomes; work closely with internal and external auditors, financial investigators, and claims processing areas + Assist in developing FWA education to train staff,… more
- US Tech Solutions (Columbia, SC)
- …health management program interventions. + Utilizes clinical proficiency and claims knowledge/analysis to assess, plan, implement, health coach, coordinate, monitor, ... data collection/input into system for clinical information flow and proper claims adjudication. + Demonstrates compliance with all applicable legislation and… more
- Guidehouse (Minneapolis, MN)
- …this position include: + Responsible for the daily resolution of assigned claims with applicable Revenue Integrity pre-bill edits and/or specific Revenue Integrity ... and associated coding modifiers. + Responsible for daily resolution of assigned claims with Revenue Integrity specific denials in the Guidehouse METRIX℠ system. +… more
- WestCare Foundation (Dandridge, TN)
- …Claim Preparation & Submission: Prepare and submit accurate and timely medical claims to insurance companies, government programs, and other payers. + Charge Entry: ... the reasons for denial, and take appropriate action to correct and resubmit claims . + Billing Audits: Perform regular audits of patient accounts to ensure accuracy… more
- Robert Half Legal (Minneapolis, MN)
- …litigation related to employee benefits, retirement plans, fiduciary duties, and claims administration. Key Responsibilities: + Assist attorneys with all aspects of ... + Summarize depositions, medical records, and plan documents relevant to benefit claims and fiduciary litigation. + Coordinate with clients, plan administrators, and… more
- Community Health Systems (Antioch, TN)
- …The Denial Coordinator is responsible for reviewing, tracking, and resolving denied claims , ensuring that appropriate appeals are submitted, and working closely with ... critical part in the denials management process, supporting efforts to improve claims resolution, reduce future denials, and ensure compliance with payer guidelines.… more
- AO Smith (Lebanon, TN)
- …provide clear guidance on company policies, processes and procedures. + Negotiate validated labor claims with Reps & non-CSP's + Travel 80% in order to support and ... and sales departments of status and disposition of customer complaints and claims . + Utilize interpersonal skills to communicate professionally at all levels within… more
- OLV Human Services (Lackawanna, NY)
- …A critical part of the role involves evaluating insurance coverage, managing claims processing, and ensuring all aspects of patient care are accurately documented ... with Finance to ensure patient charts are updated appropriately, if claims are denied/rejected. * Implement and maintain systems for insurance verification,… more