- UnityPoint Health (Ankeny, IA)
- …a timely manner. This position requires strong decision-making ability around complex claims processing workflows and regulations that requires utilization of ... to interact with Government and Commercial insurances. Why UnityPoint Health ? At UnityPoint Health , you matter. We're... issues, repetitive errors, and payer trends to expedite claims adjudication + Work accounts in assigned… more
- CVS Health (Lansing, MI)
- …Reviews pre-specified claims or claims that exceed specialist adjudication authority or processing expertise. - Applies medical necessity guidelines, ... At CVS Health , we're building a world of health...**Position Summary** Reviews and adjudicates complex, sensitive, and/or specialized claims in accordance with plan processing guidelines.… more
- Molina Healthcare (Layton, UT)
- …and regulatory guidance. The ideal candidate will bring deep knowledge of claims adjudication , QNXT system navigation, and strong analytical acumen. Experience ... compliance of Coordination of Benefits (COB) claim pricing and processing . This role will focus on identifying, reviewing, and...or equivalent experience Prior experience in Payment Integrity and/or COB/ Claims roles at a health plan or… more
- Elevance Health (AL)
- …Requires a HS diploma or equivalent and a minimum of 2 years of claims processing and/or customer service experience; or any combination of education and ... Payment Integrity is a proud member of the Elevance Health family of companies, Carelon Insights, formerly Payment Integrity,...Experiences:** + At least 2 years of experience in claims processing and customer service highly desired.… more
- Independent Health (Buffalo, NY)
- … payment. Technical Proficiency and Innovation + Retain technical knowledge of Independent Health 's customer documentation and claims processing systems to ... The COB Coordinator will also be responsible for basic claims adjudication , performing basic claim adjustments and...motor vehicle accidents, liabilities, assistant reports, as well as, processing basic Siebel service requests and Health … more
- St. Luke's Health System (Boise, ID)
- …under the pharmacy benefits. + Facilitate resolutions to issues involving claims adjudication , member concerns, and provider communications. + Addresses ... and third-party issues such as prior authorization, step therapy, reviewing denied claims , and processing overrides. Works with an interdisciplinary team of… more
- Avispa Technology (Los Angeles, CA)
- …using clinical guidelines, business applications, and customer interactions to support claims adjudication and ensure high-quality service. The company offers ... necessary information * Ensure high-quality service and compliance with claims adjudication guidelines Utilization Management Technician Qualifications: *… more
- LA Care Health Plan (Los Angeles, CA)
- …knowledge of claims coding and medical terminology. Solid understanding of standard claims processing systems and claims data analysis. Strong project ... Integrity Nurse Coder RN III Job Category: Clinical Department: Claims Integrity Location: Los Angeles, CA, US, 90017 Position...(Mid.) - $163,492.00 (Max.) Established in 1997, LA Care Health Plan is an independent public agency created by… more
- AdventHealth (Maitland, FL)
- … claims for all provider types Managed Care, Patient Financial services, health insurance claims processing , contract management, or medical economics ... reimbursement methodologies Applies detailed understanding of medical coding systems affecting the adjudication of claims to include ICD-9/10 CPT, CPT, HCPCS II,… more
- Essentia Health (Superior, WI)
- …providers, nursing staff, pharmacies, third parties, and software vendors to work through claims adjudication and processing issues to ensure payment from ... pharmacies to help ensure Medicare rules are followed when processing Medicare B billed claims + Provide...of experience (CPhT, CMA, etc.) Employee Benefits at Essentia Health : At Essentia Health , we're committed to… more