- Avera (Sioux Falls, SD)
- …and understanding of health plan processes, systems and regulations including claims processing , benefit configuration, enrollment and provider networks. ... module, which manages health plan administration, benefits, fee schedules, claims , enrollment, care coordination, clinical/authorizations and provider data. This… more
- CCMS & Associates (North Augusta, SC)
- …effectively with adjusters, insurers, and repair facilities to ensure seamless claims processing . + Maintain professional, customer-focused interactions with ... costs, and delivering high-quality appraisals for auto and heavy equipment claims . Job Responsibilities: + Conduct field inspections and appraisals of automobiles,… more
- AIG (Jeffersonville, IN)
- …extended service programs, customer service support, service network management, claims processing services, and service contract underwriting. With ... Assessments could include evaluating execution of standard operating procedures, claims policies and contractual agreements, customer experience, and/or identify… more
- LA Care Health Plan (Los Angeles, CA)
- …knowledge of claims coding and medical terminology. Solid understanding of standard claims processing systems and claims data analysis. Strong project ... Payment Integrity Nurse Coder RN III Job Category: Clinical Department: Claims Integrity Location: Los Angeles, CA, US, 90017 Position Type: Full Time Requisition… more
- Mount Sinai Health System (New York, NY)
- …Accounts Receivable, Charge Entry, Edits and Payment Posting. This individual facilitates claims processing and payments services rendered by physicians and ... problem resolution to ensure accurate and timely payment of claims and collection. The Specialist works directly with the...+ 5 years experience in medical billing or health claims , with experience in IDX billing systems in a… more
- Emory Healthcare/Emory University (Atlanta, GA)
- …journey optimization covering: onboarding, network management, utilization management interaction, claims processing , quality reporting, and value-based care ... Adoption** + Lead enterprise AI strategy identifying high-value use cases: claims processing automation, prior authorization optimization, care gap… more
- Health Care Service Corporation (Quincy, IL)
- …and meet testing criteria. * Must have trained on the six-eight-week Blue Chip claims processing system or have the ability to fully complete the six-eight-week ... **Job Summary** Under Supervision, This Position Is Responsible For Processing Complex Claims Requiring Further Investigation, Including Coordination… more
- Excellus BlueCross BlueShield (Rochester, NY)
- …Medicaid, CPT, HCPCS, ICD10, DRG, APC, RBRVS, etc.). + Extensive experience with claims processing systems, claims flow, adjudication process, system edits ... in a clear and concise manner. + Analyzes proactive detection reports and claims data to identify red flags/aberrant billing patterns. + Manages cases as assigned,… more
- Brighton Health Plan Solutions, LLC (Chapel Hill, NC)
- …maintain effective working relationships with client contacts. + Perform advanced claims processing , including professional, facility, and ancillary claims ... + Proficient in computer systems with high technical aptitude. + Advanced claims processing expertise preferred but can be trained + Strong understanding of the… more
- Geisinger (Danville, PA)
- …position provides daily support for coding and reimbursement needs across negotiations, claims processing , and provider setup. A minimum of one certification ... + Determines appropriateness of provider coding and charging practices and associated claims processing payment accuracy to validate actual provider payment… more