- Houston Methodist (Houston, TX)
- …and/or manager regarding trends to avoid further delay in claims processing. + Demonstrates understanding of fundamentals of all payors, including Medicare, ... and claim edits, payor rejections, unresolved or no response insurance claims and processing of financial correspondence. The Insurance Biller demonstrates general… 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 (Wilmington, DE)
- …mining analyses. + Prepare, verify, and manage research data sets from administrative health insurance claims databases as per provided specifications. + Uses ... management skills - will be handling large volumes of health plan administrative claims data. + Strong...Strategy. Unless specified as primarily virtual by the hiring manager , associates are required to work at an Elevance… more
- Elevance Health (Seattle, WA)
- …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 (Miami, FL)
- …Part of an Extraordinary Team** Carelon is a proud member of the Elevance Health family of companies providing unparalleled level of service in pharmacy benefits. By ... responsible for the discovery, validation, recovery, and adjustments of claims overpayments. May do all or some of the...preffered. + AA/AS preferred. 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
- Trinity Health (Ypsilanti, 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
- Sharp HealthCare (San Diego, CA)
- **Facility:** Health Plan **City** San Diego **Department** **Job Status** Regular **Shift** Day **FTE** 1 **Shift Start Time** **Shift End Time** Doctor of Medicine ... Director position provides critical management and oversight for Sharp Health Plan's (SHP) physicians (Medical Directors (both medical and...needs of the membership. Serves as a lead medical manager and policy advisor to SHP clinical and its'… more
- Beth Israel Lahey Health (Burlington, MA)
- …a difference in people's lives.** Under the managerial oversight of the Director, Senior Manager , or Manager of Revenue Cycle, the Revenue Cycle Analyst serves ... Line Directors, Managers, Finance Directors, clinical support staff, Physicians, allied health care providers, hospital colleagues, and others regarding matters that… more