- Trinity Health (Livonia, MI)
- …information is accurate, and paperwork is received timely for the submission of claims . Responds to all system issues by preparing documentation for the resolution ... + Provides statistical feedback regarding the status of unbilled claims to THAH Revenue team on a weekly basis...THAH. **Minimum Qualifications:** + **College business courses or an associate 's degree is preferred, or four to six years… 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
- Humana (Frankfort, KY)
- …issues with appropriate enterprise business teams, including those associated with claims payment, prior authorizations, and referrals, as well as appropriate ... care or managed care experience working with providers (eg, provider relations, claims education). + Experience working with physical health or behavioral health… 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
- Humana (Santa Fe, NM)
- …encompasses critical functions including care coordination, quality measurement, billing, claims processing, and customer service, each essential to delivering a ... operational knowledge of core functional areas (care coordination, quality, billing, claims , and customer service). + Collaborate with each Insurance Operations… more