- UTMB Health (Galveston, TX)
- …knowledge and understanding of medication and contract terminology;_** healthcare insurance collections, reconciliation, or analysis; supply chain management ... duplicate discounts and drug diversion to ineligible patients. Prepares self- audit reports. Ensures records and documentation for the 340B...+ Partners with IS and RCO departments to ensure claims are going out with the correct modifiers and… more
- Covenant Health Inc. (Knoxville, TN)
- …Health Overview: Covenant Health is the region's top-performing healthcare network with 10 hospitals (http://www.covenanthealth.com/hospitals/) , outpatient and ... division. Headquartered in Knoxville, Covenant Health is a community-owned integrated healthcare delivery system and the area's largest employer. Our more than… more
- Dignity Health (Bakersfield, CA)
- …deep familiarity with the complexities of delegated services, including claims , utilization management, provider data, and network operations. Essential Functions ... Optimization: Identify high-impact manual processes across departments such as Claims , UM, Credentialing, and Provider Data. Facilitate automation readiness… more
- Robert Half Finance & Accounting (Colorado Springs, CO)
- …part in ensuring accurate and efficient billing processes for a healthcare organization specializing in treatments for medication-resistant depression. The ideal ... Handle charge and code input, prior authorizations, scrubbing, timely submission of claims , secondary billing, and coordination of benefits. + Payment Posting: Post… more
- Ankura (Chicago, IL)
- …excellence founded on innovation and growth. Ankura's Global Disputes and Economics Healthcare and Life Sciences Practice is searching for a talented individual to ... firms in the United States. Ankura's Disputes and Economics Healthcare and Life Sciences Practice is the largest industry...in matters relating to compliance with the federal False Claims Act; Anti-Kickback Statute; Food Drug and Cosmetic Act;… more
- Humana (Louisville, KY)
- …development and management, or a related technical role + Strong experience with healthcare data, particularly clinical and claims data used in **HEDIS ... source selection of a complex data pipeline that powers our CMS HEDIS ( Healthcare Effectiveness Data and Information Set) rules engine. This role bridges product… more
- Elevance Health (Indianapolis, IN)
- **Provider Auditor -** FRD > Audit **Hybrid 1:** This role requires associates to be in-office **1 - 2** days per week, fostering collaboration and connectivity, ... + Schedules review with provider, analyzes data to select claims to be reviewed, conducts review using medical charts,...dedicated to improving lives and communities - and making healthcare simpler. We are a Fortune 25 company with… more
- WM (Sturtevant, WI)
- …across a range of increasingly complex and highly regulated arenas, serving healthcare organizations and commercial businesses of every size. Every day, we help ... compliance. Also responsible for local coordination and management of claims -related activities, including working closely with third party administrators (TPA)… more
- Elevance Health (Atlanta, GA)
- …potential issues, project change, and scope data, with a focus on payment accuracy, claims validation, and audit readiness. + Leads efforts to identify best ... business needs, including those unique to payment integrity and claims operations. + Designs methods for integrating functions and...dedicated to improving lives and communities - and making healthcare simpler. We are a Fortune 25 company with… more
- Otsuka America Pharmaceutical Inc. (Rockville, MD)
- Otsuka is a global healthcare company that has been in business for more than 100 years driven by the corporate philosophy: "Otsuka people creating new products for ... but not limited to Compliance Committee updates, quarterly reports to the OAPI/OPDC Audit & Risk Committee and Joint Boards of Directors, Annual reports, and updates… more