- Elevance Health (Denver, CO)
- …and DRGs billed and reimbursed. Specializes in review of Diagnosis Related Group (DRG) paid claims . **How you will make an impact:** + Analyzes and audits claims ... applicable state(s). + Requires a minimum of 10 years of experience in claims auditing, quality assurance, or clinical documentation improvement, and a minimum of 5… more
- Elevance Health (Norfolk, VA)
- …with external accreditation and regulatory requirements, internal policies and claims events requiring adaptation of written response in clear, understandable ... and analyze the grievance and appeal issue(s) and pertinent claims and medical records to either approve or summarize...skills, and analytical skills. Please be advised that Elevance Health only accepts resumes for compensation from agencies that… more
- Elevance Health (Indianapolis, IN)
- …eligible for employment based sponsorship. **Ensures accurate adjudication of claims , by translating medical policies, reimbursement policies, and clinical editing ... research and responds to system inquiries and appeals. + Conducts research of claims systems and system edits to identify adjudication issues and to audit … more
- Elevance Health (Mendota Heights, MN)
- …The **Excess Loss Specialist** is responsible for working independently reviewing claims and interpreting contracts. Works with complex concepts of excess loss, ... an impact :** + Assists auditors with obtaining information for stop loss claims . + Tracks payments from third-party administrators that have been funded. + Prepares… more
- Brighton Health Plan Solutions, LLC (Chapel Hill, NC)
- …but can be trained + Strong understanding of the healthcare industry and claims processing (preferred). About At Brighton Health Plan Solutions, LLC, our ... About The Role Brighton Health Plan Solutions is seeking an Account Supervisor...effective working relationships with client contacts. + Perform advanced claims processing, including professional, facility, and ancillary claims… more
- Evolent (Helena, MT)
- …growth opportunities at customer accounts + Strong knowledge of health plan operations, care/utilization management, claims processing, value-based ... **Your Future Evolves Here** Evolent partners with health plans and providers to achieve better outcomes...to identify opportunities and actions (including EMR, clinical, authorization, claims , SDoH, etc.); understanding of how to translate data… more
- Taiho Oncology (Princeton, NJ)
- …/ monthly / quarterly reporting to senior management. + Work with patient level claims , account, and Health Care Professional (HCP) sales data to answer business ... analytics / sales / managed markets experience. + Knowledge of US health care market. + Oncology therapeutic experience preferred. Knowledge of the diverse… more
- World Insurance Associates, LLC. (Mount Laurel, NJ)
- …consulting, collaborating with the team to resolve issues (eligibility, carrier coverage and claims issues, compliance; health care reform, HIPAA). + Lead the ... or equivalent education and/or experience in the insurance industry. + Life/ Health insurance license (or the ability to obtain necessary licensing immediately)… more
- Atlantic Health System (Morristown, NJ)
- …with the ability to handle a variety of matters related to claims , policy development, and professional review activities. Responsibilities + Review professional ... liability claims and...litigation experience + Management Experience Preferred #LI-AW1 At Atlantic Health System, our promise to our communities is; Anyone… more
- Covenant Health Inc. (Knoxville, TN)
- …Claim Follow-Up Full Time , 80 Hours Per Pay Period, Day Shift Covenant Health Overview: Covenant Health is the region's top-performing healthcare network with ... area's fastest-growing physician practice division. Headquartered in Knoxville, Covenant Health is a community-owned integrated healthcare delivery system and the… more