- LogixHealth (Dania, FL)
- Location: On-Site in Dania, FL This Role: As a Claims Specialist, you will work with internal teams to provide cutting-edge solutions that will directly improve the ... healthcare industry. You'll contribute to our fast-paced, collaborative environment...and carry out processes on all out of network claims . The ideal candidate will have strong technological skills,… more
- Molina Healthcare (Iowa City, IA)
- …the core claims processing system (QNXT). * Clearly documents the audit results and makes recommendations as necessary. * Helps to evaluate the adjudication ... fraudulent billing practices, waste, overpayments, and processing errors of claims . * Prepares, tracks, and provides audit ...of experience in claims as Adjuster or claims examiner in the healthcare field **PHYSICAL… more
- Commonwealth Care Alliance (Boston, MA)
- …(must have): * 5+ years in healthcare compliance, regulatory affairs, or claims audit . * Experience working with TPA partners (eg, Cognizant) and submitting ... 011250 CCA- Claims **_This position is available to remote employees...for ensuring CCA's operational compliance with state and federal healthcare regulations, particularly MassHealth (Massachusetts Medicaid) and CMS Medicare… more
- Guidehouse (San Marcos, CA)
- …is expected to perform all areas of initial billing, secondary billing, and payer audit follow-up for government and non-government claims . Must work with other ... Billing Emphasis + Correcting and billing electronic and hardcopy claims + Submits Adjusted claims + Provides...or insurance information. + Works all rejection and payer audit reports within 48 hours of receipt taking whatever… more
- Prime Healthcare (Ontario, CA)
- …improve the quality and minimize process cost of Claims for all Prime Healthcare 's self-insured Employee Health Plans. Through in-depth audit and review of ... Connect With Us! (https://careers-primehealthcare.icims.com/jobs/196005/vice-president-of-health-plan-operations-and- claims /job?mode=apply&apply=yes&in\_iframe=1&hashed=-336024306) FacilityPrime … more
- Grant Thornton (Los Angeles, CA)
- As a Healthcare Process Risk Senior Associate, you will get the opportunity to grow and contribute to our clients' business needs by helping them understand their ... The ideal candidate will have exceptional expertise and experience in healthcare providers, specifically hospitals, academic medical centers, and healthcare … more
- LogixHealth (Dania, FL)
- …teams to provide cutting edge solutions that will directly improve the healthcare industry. You'll contribute to our fast-paced, collaborative environment and bring ... issues and appeal if necessary, using software or other resource tools + Prepare audit results and keep department manager current of all findings and audits and… more
- Humana (Lansing, MI)
- …part of our caring community and help us put health first** The Senior Claims Research and Resolution Professional reports to the Claims Research and Resolution ... Lead and is responsible for tracking and trending Michigan Medicaid claims data and completing root cause analyses of claims denials or rework, underpayments,… more
- Commonwealth Care Alliance (Boston, MA)
- …billing-related certifications **Required Experience (must have):** + 3+ years in healthcare claims processing, provider reimbursement, or payment integrity. + ... 011250 CCA- Claims **_This position is available to remote employees...claims systems (eg, Salesforce, Facets) in compliance with audit standards and MassHealth requirements. + Maintain awareness of… more
- CHS (Clearwater, FL)
- **Overview** ** ** ** Claims and Call Auditor (Call Center QC) - Clearwater, FL** ** ** **Summary** The Claims & Call Auditor audits processed medical insurance ... medical audits, target audits, re-audits, etc and audits for claims which are in excess of payment authority limits...are in excess of payment authority limits in assigned audit queues. + Listen to and view all recorded… more