- CVS Health (AZ)
- …representatives that are responsible for contacting payers to collect on unpaid claims in a timely and accurate manner, researching and resolving payment variances, ... and managing the accurate and timely filing of claims within payer function group. **Additional responsibilities of the... in accordance with the respective contract + Assist management with meetings with key payers to discuss reimbursement… more
- LA Care Health Plan (Los Angeles, CA)
- …Continued Domain Specific Experience and Skills: Domain Focus: Authorization & Claims Operations Analytics Required: Experience with Utilization Management (UM) ... authorization workflows and prior authorization metrics. Knowledge of claims operations, including receiving, adjudication, and provider dispute resolution.… more
- Unum Group (Portland, ME)
- …The Benefits Coordinator (BC) role is accountable for managing a block of claims for payment, settlement, and/or triaging depending on area of specialty. BCs have ... responsibility for understanding the current situation with the claims and activities for which they are responsible. This will be done through file reviews; ongoing… more
- CareFirst (Baltimore, MD)
- …overpayment results; communicating findings to the Payment Integrity Workgroup and Management . The incumbent will be responsible for assessing and implementing new ... new concepts that will target claim overpayment scenarios. Performs analysis on claims , provider data, enrollment data, medical policies, claim payment policies for… more
- City of New York (New York, NY)
- …- Manage area essential to sensitive and accurate claiming and accounting for claims submitted to the State to ensure that all expenses designated for claiming ... deadlines - Perform an audit/quality control review of completed claims for accuracy and for compliance with State and...Federal, State and City - Interface with Office of Management and Budget (OMB) regularly on all revenue issues… more
- Bloom Healthcare (Lakewood, CO)
- …inquiries. Duties/Responsibilities: + Oversee the submission of accurate and timely claims to payers, ensuring compliance with regulatory and contractual guidelines. ... claim status and follow up on unpaid or denied claims . + Investigate discrepancies and coordinate with payers and.... + Utilize electronic health record (EHR) and practice management systems for billing and collections. + Implement process… more
- MyFlorida (West Palm Beach, FL)
- …CANDIDATES WITH THE FOLLOWING: + Experience working with State Attorney overpayment claims + Experience with problem-solving techniques within a work group + Three ... more complex cases for investigation, calculation and recovery of overpayment claims for government assistance programs (Temporary Cash Assistance, Food Assistance,… more
- Highmark Health (Pittsburgh, PA)
- …Description :** Date Posted: 20260109 Location: Allegheny General Hospital Department: Case Management , Inpatient Status: Part Time Shift: 48 hours every two weeks ... M-F, 24 hours per week, rotating weekends and holidays Union: Yes **CASE MANAGEMENT :** The Case Management Department at Allegheny General Hospital assists… more
- Wells Enterprises (PA)
- …Sales Finance to reconcile deductions **Wells Execution** + Annual Planning / CPT Management / Forecast/ Trade + Deductions/ Claims Reconciliation + Shopper / ... Ecomm Partnership + Ordering Samples + PO Tracking + Ferrero/Ferrera Partnership + Business Planning Meetings (ie. Top Tier, Fast Start, etc) **Requisition ID** : 2209015 more
- Cognizant (Austin, TX)
- … management . Documented technical skills, Excel, Payer Portals, and Claims Clearinghouses. **Salary and Other Compensation:** Applications will be accepted until ... and respond using medical guidelines and policies Prioritize pending claims from aging basket and follow up at regular...Excel skills to summarize and provide detailed reporting to management and client Tracks and trends claim denials and… more
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