- The Cigna Group (Bloomfield, CT)
- …to gain knowledge of Pharmacy Benefit Management (PBM) services, including claims processing , coverage reviews, pharmacy networks, formulary management, and ... client management. + Effectively participate in and contribute to staff meetings, committees and departmental work groups to share best practices, improve processes and/or other items relating to provider engagement. + Provide patient and health care… more
- UPMC (Pittsburgh, PA)
- …terminology and coding. + In-depth knowledge of electronic data interchange and claims processing , third party payer rules, reimbursement practices and ... regulatory guidelines. + Proficient with MS Word, Excel and Outlook. + Excellent client service skills. + Excellent written and verbal communication skills. + Ability to coordinate projects to meet the needs of users and establish priorities, make decisions… more
- Sunnyside Nursing and Post-Acute Care (Torrance, CA)
- …procedural codes to individual patient information for data retrieval analysis and claims processing . Queries physicians and/or oversees the query process when ... code assignments are not straightforward or documentation in the record is inadequate, ambiguous, or unclear for coding purposes. Abides by the standards of ethical coding as set forth by the American Health Information Management Association and adheres to… more
- AbbVie (North Chicago, IL)
- …degree or comparable experience in Healthcare Finance, Revenue Cycle, Insurance Claims Processing and/or Specialty Pharmacy Operations. + Individuals must ... meet applicable Pharmacy Technician Licensure and Certification requirements no later than the first day of employment. + A minimum of 3-5 years' experience within a healthcare provider, PBM, Specialty Pharmacy or Retail/Mail Order Pharmacy setting,… more
- CDPHP (Latham, NY)
- …two (2) years Utilization Management experience is preferred. + Knowledge of coding/ claims processing is preferred. + Experience working with Microsoft Office, ... including Outlook, Word and Excel, and other databases required. + Demonstrated ability to pro-actively identify problems and recommend solutions. + Demonstrated ability to stay organized and work effectively within strict deadlines. + Demonstrated ability to… more
- CVS Health (Richardson, TX)
- …role in ensuring the stability, scalability, and modernization of our pharmacy claims processing systems. These systems handle millions of prescriptions daily, ... directly impacting the health and well-being of our customers. You will lead technical initiatives, support platform health, and drive continuous improvement across our IBMi-based infrastructure. **We prefer candidates be hybrid in Richardson, TX but can… more
- Capital One (New York, NY)
- …our systems and platforms that power Fraud defenses and Fraud & Disputes claims processing + Partner cross-functionally with client, cloud infrastructure, and ... machine learning platform teams to align on and co-develop technical solutions. + Architect and build highly secure & scalable systems that enable server-driven product experiences across devices, with exceptional reliability and availability. + Design… more
- Seattle Children's (WA)
- …in data analysis and financial reporting. Knowledge of Epic Willow and pharmacy claims processing . Epic certified in modules supported or receive certification ... within 6 months from employment. Experience with financial audits and compliance monitoring. **Required Credentials** Licensed by the Washington State Board of Pharmacy as a Pharmacist or Licensed Pharmacist in good standing in the state that you are working… more
- Great River Health (West Burlington, IA)
- …+ Verify insurance benefits and eligibility to facilitate smooth billing and claims processing . + Troubleshoot scheduling conflicts and coordinate solutions with ... clinical and administrative staff. + Educate patients on scheduling policies, pre-appointment requirements, and available resources. + Collaborate with administrative and clinical staff to optimize scheduling processes and improve patient flow. + Maintain an… more
- CareFirst (Baltimore, MD)
- …and procedures, including experience with providers, training, customer service, and claims processing . **Preferred Qualifications:** + Bachelor's Degree in ... business, healthcare administration or related industry. **Knowledge, Skills and Abilities (KSAs)** + Working knowledge of provider billing and coding mechanisms, including special pricing, medical terminology, CPT coding and CMS-1500 or CMS UB -04 claim… more