- Highmark Health (Tallahassee, FL)
- …for proactive and investigative purposes to comply with internal audit and regulatory requirements. **ESSENTIAL RESPONSIBILITIES** + Performs investigations into ... Credentialing or Medical Review Committee. + Engages in delivery of audit results and overpayment negotiations.Responsible for recovery/ savings of misappropriated… more
- UPMC (Pittsburgh, PA)
- …modification to policies and procedures. + Completion of special projects including focused claims diagnosis codes and/or coding related audit support. + Assists ... records for Hierarchical Condition Category (HCC) diagnosis codes for focused claims reviews and government audits. Performs auditing functions including monitoring,… more
- Trinity Health (Ann Arbor, MI)
- …for the purpose of establishing the patient and service specific record for claims processing and maintenance of an accurate electronic medical record. Registers and ... information system(s), to ensure accurate and timely submission of claims . Determines visit-specific co-payments and collects out-of-pocket liabilities. Assists… more
- Trinity Health (Howell, MI)
- …for the purpose of establishing the patient and service specific record for claims processing and maintenance of an accurate electronic medical record. Registers and ... information system(s), to ensure accurate and timely submission of claims . Determines visit-specific co-payments and collects out-of-pocket liabilities. Assists… more
- Avera (Sioux Falls, SD)
- …within the configurations department to ensure high quality and consistency of core claims processing and ensure integrity of audit protocols via the variance ... employer. **Required Education, License/Certification, or Work Experience:** + 4-6 years Health insurance experience, including experience with claims systems,… more
- Sedgwick (Pierre, SD)
- …United States. **PRIMARY PURPOSE** : Performs standard clinical evaluations on claims that require additional review based on medical condition, client requirement, ... FUNCTIONS and RESPONSIBILITIES** + Consults on and evaluates complex claims to determine objective, quantifiable, medically supported work restrictions/accommodations.… more
- CVS Health (Scottsdale, AZ)
- …within PBM or Health Care industry. **Preferred Qualifications** + Quality assurance audit experience. + 8+ years PBM or Health Care industry experience. + ... At CVS Health , we're building a world of health...all delivery systems and adjudication platforms related to pharmacy claims adjudication. You will inspect the correct application of… more
- Community Health Systems (Birmingham, AL)
- …reports issues, problems, and important information to management. + Works all vendor/payer audit trails and files secondary claims . + Performs other duties as ... companies or other payers. This position performs all needed research to ensure claims are filed timely, accurate and efficient in accordance with all billing… more
- AON (New York, NY)
- …What the day will look like As respects property damage and business interruption claims + Review, audit and analyze accounting books and records, financial ... sick leave laws, short-term disability and optional long-term disability, health savings account, health care and dependent...look like As respects property damage and business interruption claims + Review, audit and analyze accounting… more
- City of Boise (Boise, ID)
- …This role is pivotal in coordinating workers' compensation and liability claims , insurance renewals, and risk-related investigations. The right candidate is ... Processes, investigates and provides recommendations for liability and workers' compensation claims by compiling, verifying the accuracy of, completing research and… more
Recent Jobs
-
Freedom Boat Club - Seasonal Dock Master at Clarks Hill, GA (through October)
- Brunswick (Appling, GA)