- Western Washington University (Bellingham, WA)
- …insurance company contracts and regulations. + Ensures compliance and completeness of claims for electronic submission. + Ensures proper billing by State and Federal ... regulations by overseeing coding audit efforts and coordinates monitoring of coding accuracy and...and any legal updates or other considerations. + Reviews claims denials and rejections pertaining to coding and medical… more
- Independent Health (Buffalo, NY)
- …system administration and reporting, vendor delegation oversight, medical pharmacy claims processing and training. They will establish and monitor performance ... + Accountable for development and production of regulatory reporting to meet/exceed audit requirements. + Accountable for business need reporting to track metrics,… more
- CDPHP (Albany, NY)
- …team's delivery of the analysis, maintenance, and configuration of CDPHP's core claims systems and applications application systems, as well as modifying existing ... state and federal mandates to ensure the successful configuration of CDPHP's core claims systems and any integrated systems. The Configuration Analyst III will be… more
- Humana (Baton Rouge, LA)
- …certification(s) (Clinical Certifications, CPC, CCS, CFE, AHFI) + Understanding of healthcare industry, claims processing and investigative process development + ... of fraud, waste, and abuse involving providers who submit claims to Humana's Louisiana Medicaid line of business. The...ensuring appropriateness of billing practices + Prepare investigative and audit reports To thrive in this role, the following… more
- Elevance Health (St. Louis, MO)
- …unit/brand as appropriate regarding approved interventions such as recovery of overpayment, pre-payment audit of claims or putting providers on notice. + Trains ... + Performs in-depth investigations on identified providers as warranted. + Examines claims for compliance with relevant billing and processing guidelines and to… more
- Robert Half Accountemps (Los Angeles, CA)
- …and tracking actionable follow-ups. Requirements EMR (Electronic Medical Records), Healthcare regulations, Audit Management, Medi-Cal, Excel Formulas, Health ... Description A National Healthcare Organization is seeking a knowledgeable and detail-oriented...the effectiveness of insurance and risk management programs. + Claims Management: Collaborate with the Risk Management team to… more
- Terumo Medical Corporation (Somerset, NJ)
- …used in a broad range of applications for numerous areas of the healthcare industry. TMC places a premium on providing customers with world-class products, training ... think outside the box, experiment, innovate and deliver what's next for quality healthcare . You will be part of a collaborative, respectful and resilient team of… more
- Robert Half Accountemps (Gibsonia, PA)
- …within healthcare or senior care environments. * Proficiency in healthcare billing systems and familiarity with Medicare/Medicaid claims and insurance ... Description We are looking for a meticulous Healthcare Healthcare Billing and Accounts Receivable...home care, hospice, and outpatient therapy. + Submit accurate claims to insurance providers, Medicare, and Medicaid in compliance… more
- Trinity Health (Ann Arbor, 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
- Centene Corporation (Oklahoma City, OK)
- …in managed care environment, medical provider office, customer service within a healthcare organization, and medical claims . Knowledge of health care, managed ... up accurately in the provider information system for state reporting, claims payment, and directories. Responsible for multiple state deliverables, network reporting… more