- WellSpan Health (York, PA)
- …qualified patients, drugs and locations. Monitors and audits state Medicaid claims to ensure compliance to prevent potential duplicate discount rebates. Evaluates ... qualified patients, drugs, and locations. - Monitors and audits state Medicaid claims to ensure compliance to prevent potential duplicate discount rebates. - Uses… more
- Elevance Health (Chicago, IL)
- …PI areas (Data Mining, Coordination of Benefits, Complex and Clinical Audit, Claims Edits, and the Special Investigations Unit) operating as an internal consultant ... and leadership roles, with specific knowledge in payment integrity, provider, and claims domains. + Lean Six Sigma Black Belt certification; Master Black Belt… more
- Elevance Health (Independence, OH)
- …volume of provider. + Schedules review with provider, analyzes data to select claims to be reviewed, conducts review using medical charts, medical notes, itemized ... + Verifies dollar amount on claim is correct in claims system and writes report of the findings of...provide an equivalent background. Please be advised that Elevance Health only accepts resumes for compensation from agencies that… more
- Elevance Health (FL)
- …_PLEASE NOTE: This position is not eligible for current or future visa sponsorship._ Carelon Health is a proud member of the Elevance Health family of brands, ... Senior** measures financial performance of core Carelon products leveraging claims , authorization, and membership data to tell a detailed...SAS required, and a minimum of 3 years in health care setting; or any combination of education and… more
- Henry Ford Health System (Troy, MI)
- …work remotely Under minimal supervision, is responsible for the Henry Ford Health System Insurance accounts receivable. Identifies and determines in accordance with ... of patient financial, insurance and demographic patient information to ensure compliant claims to Third party payers. Resolves problem accounts from payer denials… more
- Carle Health (Urbana, IL)
- …improve revenue cycle activities for prior authorizations, documentation, billing and claims . Understands regulatory and third party payer guidelines for admissions, ... healthcare trends in authorization, insurance verification and benefits, reimbursement, claims denials, and hospital/clinical management + Identifies, discusses, plans… more
- Elevance Health (Indianapolis, IN)
- …complex provider issues and appeals for prompt resolution. + Coordinates prompt claims resolution through direct contact with providers and claims department. ... Locations: California; Minnesota. In addition to your salary, Elevance Health offers benefits such as, a comprehensive benefits package,..._._ * The salary range is the range Elevance Health in good faith believes is the range of… more
- Mount Sinai Health System (New York, NY)
- …for reviewing, summarizing, analyzing, presenting and monitoring safety events, claims management, loss prevention and reduction, patient safety related quality ... day to day risk management activities the Mount Sinai Health System (MSHS)., The Clinical Risk Manager conducts investigations...Interface with the insurers and legal counsel, reporting potential claims as well as cases of concern by preparation… more
- Hawaii Pacific Health (Honolulu, HI)
- Hawai'i Pacific Health is a not-for-profit health care network with over 70 locations statewide including medical centers, clinics, physicians and other ... Pali Momi, Straub and Wilcox - specialize in innovative programs in women's health , pediatric care, cardiovascular services, cancer care, bone and joint services and… more
- Elevance Health (New York, NY)
- …via telephone regarding insurance benefits, provider contracts, eligibility and claims . + Analyzes problems and provides information/solutions. + Operates a ... limited knowledge of company services, products, insurance benefits, provider contracts and claims . Seeks, understands and responds to the needs and expectations of… more