- Integra Partners (Troy, MI)
- …with administrative and non-clinical tasks related to processing Utilization Management prior authorization sand appeals. JOB RESPONSIBILITIES + Monitor incoming ... codes + Verify eligibility and claim history in proprietary claims platform + Verify all necessary documentation has been...expectations and functions of the UM team + Time Management What will you achieve in the first 12… more
- Guthrie (Cortland, NY)
- …with less than one year of experience) Summary The LPN Utilization Management (UM) Reviewer, in collaboration with Care Coordination, Guthrie Clinic offices, other ... Business Office, is responsible for the coordination of Utilization Management (UM) processes and requirements of prior authorization/certification for reimbursement… more
- Burns & McDonnell (Chicago, IL)
- …downstream contract administration including request for information (RFI's), submittals, change management , contract closeout, and claims mitigation. + Other ... scope and fee development, staffing plan development, project oversight, quality management , and financial performance responsibilities. A major emphasis will be… more
- Pilgrim's (Mount Pleasant, TX)
- …require outside medical care to third part administrator (TPA), imitation of internal case management on workers' compensation claims . 6. Adhere to all state and ... nursing assessment, first aid, follow-up care, rehabilitation service, and case management . 5. Coordinate all workers' compensation management including,… more
- Caris Life Sciences (Irving, TX)
- …future issues. + Identifying and communicating process errors to optimize revenue cycle management . + Utilize payor portals to gather claims status information. ... The Account Receivable Associate is responsible for reviewing outstanding denied claims with Medicare, Medicaid and Commercial insurance companies. This role… more
- State of Colorado (Denver, CO)
- …from inception through hearings and appeals, including fully contested claims , challenges to specific disability and medical benefits, penalty allegations, ... Unit provides formal training and day-to-day advice to the state Risk Management 's Workers' Compensation Division, state agencies, and the State's third party-… more
- U-Haul (Phoenix, AZ)
- …Compensation Injury Counselor to be responsible for the handling and oversight of complex claims as a result of on the job injuries. Under the direction of the ... Vice President of Claims , the successful candidate will coordinate all related activity...candidate will coordinate all related activity with local team management , the Third-Party Administrator, medical case management … more
- AIG (Jeffersonville, IN)
- The Operations Claims Analyst will work closely with the Service and Claims Operations teams to identify and pursue opportunities for evaluating business ... + Communicate and execute initiatives in partnership with Service and Claims Operations. + Proactively identify process improvements. + Maintain good working… more
- Defense Logistics Agency (Richmond, VA)
- …labor and non-labor execution against approved funding levels for senior management . Responsible for overall civilian personnel interaction to include processing ... analysis of differences, prepares reports and presentations to senior management . Provide recommendations for modifications based on program analysis performed… more
- Health Care Service Corporation (Philadelphia, PA)
- …needed support services for our clients. This person is responsible for the management , mentoring and training of a team responsible for provider contracting and ... + Extensive knowledge of provider and facility contracting, products, and claims /processing systems. + Leadership skills to oversee staff, implement initiatives, and… more
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