• Medical Biller II, CMG Business Office

    Covenant Health Inc. (Knoxville, TN)
    …Customer Service, Collections, Payment Posting) as it pertains to plan eligibility, claims processing details, and patient balance explanations as needed. + ... + Provides accurate explanation to patients with questions related to claims processing , plan benefits, and account balances via verbal and written… more
    Covenant Health Inc. (11/21/25)
    - Related Jobs
  • Government Operations Consultant II

    MyFlorida (Fort Lauderdale, FL)
    …and determining managed care compliance with the SMMC contract as it relates to claims processing . Examples of work include: Analyzes programmatic reports of ... plans related to compliance with contract provisions, provider reimbursement and claims processing requirements. Maintains up-to-date knowledge concerning the… more
    MyFlorida (12/25/25)
    - Related Jobs
  • Risk Management Professional

    Humana (Lincoln, NE)
    …+ Develop and recommend controls and cost-effective approaches to minimize claims processing risks. + Will perform advanced administrative/operational/customer ... and institutional claims reimbursement + Strong knowledge of TRICARE policy and claims processing + Able to work 8 hour shift between the hours of 7 am… more
    Humana (12/13/25)
    - Related Jobs
  • Payment Integrity DRG Coding & Clinical Validation…

    Excellus BlueCross BlueShield (Rochester, NY)
    …. Ensures accurate payment by independently utilizing DRG grouper, encoder, and claims processing platform. . Manages case volumes and review/audit schedules, ... business analysis. . Intermediate knowledge of PC, software, auditing tools and claims processing systems. Level II (in addition to Level I Qualifications) .… more
    Excellus BlueCross BlueShield (10/23/25)
    - Related Jobs
  • Manager of Data Management

    HCA Healthcare (Nashville, TN)
    …the Data management team. The Data Management team is responsible for ensuring that claims processing platform is optimally and accurately configured to meet the ... technical professionals. **Duties include, but not limited to:** + Ensure claims processing platform is optimally and accurately configured and maintained to… more
    HCA Healthcare (12/28/25)
    - Related Jobs
  • Appeals & Grievances Specialist (Complaints…

    Molina Healthcare (Bridgeport, CT)
    …concisely, accurately and in accordance with regulatory requirements. * Researches claims processing guidelines, provider contracts, fee schedules and systems ... or equivalent combination of relevant education and experience. * Health claims processing experience, including coordination of benefits (COB), subrogation… more
    Molina Healthcare (12/14/25)
    - Related Jobs
  • Contract Support and RCM Analyst - Independent…

    Public Consulting Group (St. Paul, MN)
    …through claim issue research. Additional this position will assist in performing claims processing , medical record audits for all implemented agencies, and ... claim issue research. Additional this position will assist in performing claims processing , medical record audits for all implemented agencies, and assist with… more
    Public Consulting Group (12/02/25)
    - Related Jobs
  • Assistant Team Lead Workers Compensation

    Sedgwick (Bartlesville, OK)
    …team meetings and assigns accountability for follow-up items. + Gathers important compliance/ claims processing information to be presented at team meetings. + ... **PRIMARY PURPOSE:** To analyze complex or technically difficult workers' compensation claims to determine benefits due; to work with high exposure workers'… more
    Sedgwick (12/09/25)
    - Related Jobs
  • Billing Specialist

    Masonicare (Wallingford, CT)
    …established procedures. - Works with - operations to resolve - issues that impact claims processing . Brings problems and delinquent responses to the attention of ... Manager. Process- corrections - and generate- claims for re- processing . - - Reviews denials and zero pay claims from payor remittance advices, research… more
    Masonicare (12/09/25)
    - Related Jobs
  • Senior Contracting Compliance Analyst…

    Mount Sinai Health System (New York, NY)
    …processes, and related regulations. ? Familiarity with contract terms, NYS regulations, claims processing , and healthcare reimbursement models. ? Experience in ... contract language to ensure proper interpretation and application of terms during claims processing . * Ensure that all contract terms are being adhered to in… more
    Mount Sinai Health System (10/08/25)
    - Related Jobs