- Martin's Point Health Care (Portland, ME)
- …(USFHP). + Demonstrates advanced knowledge of enrollment / disenrollment guidelines, claims processing and plan benefits necessary to exercise decision-making ... in Microsoft Outlook, Word, Excel, TruCare and Salesforce. Experience with QNXT Claims Adjudication Platform strongly preferred. Abilities + Exceptional written… more
- Saint Francis Health System (Tulsa, OK)
- …oversight to maximize cash flow, reduce accounts receivable days, and ensure effective claims adjudication . This position plays a key role in monitoring ... all aspects of patient financial services including professional and hospital claims billing, cash posting, and management of patient receivables. This role… more
- Catholic Health Services (Centereach, NY)
- …Experience in Epic or similar EMR platforms Experience with retail pharmacy prescription processing and claims adjudication Prior experience on pharmacy ... Overview Catholic Health is one of Long Island's finest ...related experience Previous experience in a specialty pharmacy and/or processing prior authorizations is highly desirable Experience with 340B… more
- Sharp HealthCare (San Diego, CA)
- …management team. + Knowledge of Federal and State regulations as related to benefit and claims adjudication . + Adept at being an initiator of positive change to ... and responding to internal and external benefit inquiries, and supporting claims testing activities. Provides training to new and less experienced Benefit… more
- System One (Dayton, OH)
- …Enrollment, 837 Claims , 835 Remittance Advice, etc. Strong healthcare EDI Processing - Facets adjudication platform a plus. This position supports TRICARE ... NCPDP transactions is an advantage but not required. + Claims adjudication systems: Knowledge of FACETS or...partner for our clients, but we offer eligible employees health and welfare benefits coverage options including medical, dental,… more
- HUB International (Chicago, IL)
- …audits of Pharmacy Benefit Managers (PBMs) to ensure contractual compliance, accurate claims processing , and proper financial management. This role involves ... Microsoft Excel (advanced functions) and SQL. + Familiarity with PBM platforms and claims adjudication systems. + Strong understanding of pharmacy billing and… more
- University of Rochester (Rochester, NY)
- …as to why claims are not paid and steps necessary for processing /payment. + Initiate collection phone calls to insurance companies to determine reason for claim ... add-ons + Follow up with payers on incorrectly paid claims through final resolution and adjudication , including...and monthly reports and work lists via calculating and processing transactions such as payer to payer transfers, contractual… more
- University of Rochester (Rochester, NY)
- …as to why claims are not paid and steps necessary for processing /payment. - - Initiate collection phone calls to insurance companies to determine reason for ... - - Follow up with payers on incorrectly paid claims through final resolution and adjudication , including...and monthly reports and work lists via calculating and processing transactions such as payer to payer transfers, contractual… more
- Essentia Health (Superior, WI)
- …pharmacy technician experience + Previous experience working with patient medication profiles, claims adjudication and billing, copay assistance programs as well ... of the pharmacy team and will assist in the adjudication , processing , packaging and distributive functions of...optimal specialty pharmacy performance. Team members within the Essentia Health Pharmacy will have an opportunity to be part… more
- Emory Healthcare/Emory University (Atlanta, GA)
- …with providers, negotiate contracts (where necessary), and ensure quality of care. CLAIMS MANAGEMENT: + Oversee TPA claim processing , ensure accurate and ... with the finance team to manage the budget and financial performance of the health plan, the VP Pharmacy for performance on pharmaceutical spending targets, and the… more