- Highmark Health (Pittsburgh, PA)
- …employees. **GENERAL OVERVIEW** This job oversees, develops, and manages the end-to-end claims functions and operational inputs including but not limited to the ... receipt of claims , operational correspondences, and corporate correspondences for multiple customer segments; fully utilizes the support mechanisms available to… more
- Dana-Farber Cancer Institute (Brookline, MA)
- …and Gift of Life accounts to ensure accurate reimbursement and final adjudication of claims as needed. Works prebilling edits in the billing and scrubber systems to ... ensure timely submission of claims in accordance with department expectations. May also perform...information including physician numbers assigned by governmental agencies and insurance carriers. Located in Boston and the surrounding communities,… more
- Sedgwick (Columbus, OH)
- …as a Great Place to Work(R) Fortune Best Workplaces in Financial Services & Insurance RN Utilization Review **PRIMARY PURPOSE** : To utilize evidence based tools to ... Acts as a resource in consulting with the client, nursing staff and claims examiners regarding pharmacy issues. + Performs drug utilization reviews through the… more
- HCA Healthcare (San Antonio, TX)
- …plans (accident, critical illness, hospital indemnity), auto and home insurance , identity theft protection, legal counseling, long-term care coverage, moving ... assistance, pet insurance and more. + Free counseling services and resources...of Trustees. Include the patient's story of harm. Risk Management/ Claims Activities (if not otherwise assigned) - Collaborate with… more
- Corewell Health (Grand Rapids, MI)
- …(external medical records, internal documentation from enterprise-wide systems including: claims payments, billing and enrollment, care management, medical, pharmacy ... and behavioral health authorizations, customer service interactions, prescription claims , medical policies, and plan documents).Evaluate information gathered to… more
- Gentiva (Mooresville, NC)
- …with billing, collections, and field staff to ensure compliance and smooth claims processing. **As a Clinical Authorization Nurse, You Will:** + Perform reviews ... + Manage and communicate with the team regarding the appeals process for claims + Collaborate with Directors of Billing and Collections to maintain compliance with… more
- Health Care Service Corporation (Belleville, IL)
- …Under Supervision, This Position Is Responsible For Processing Complex Claims Requiring Further Investigation, Including Coordination Of Benefits And Resolving ... Pended Claims . **Required Job Qualifications:** * High School diploma or...pension plan, paid time off, paid parental leave, disability insurance , supplemental life insurance , employee assistance program,… more
- TEKsystems (Sterling, VA)
- …Role The Entry-Level Medical Collector supports by following up on aged hospital claims , resolving denials, and contacting insurance payers or patients to ... determine next steps. Once trained, you'll manage 20-30 claims per day, working across multiple systems to ensure...Responsibilities + Make outbound and inbound calls to patients, insurance companies, and internal teams + Review and resolve… more
- Sedgwick (Southfield, MI)
- …as a Great Place to Work(R) Fortune Best Workplaces in Financial Services & Insurance Senior Operations Manager **Our teams connect! We collaborate onsite and have a ... + Establishes policy and procedure to assure compliance to best practices, claims management services standards, state regulations and client service requirements. +… more
- Sedgwick (Tampa, FL)
- …Great Place to Work(R) Fortune Best Workplaces in Financial Services & Insurance Utilization Review Coordinator **PRIMARY PURPOSE** : To assign utilization review ... as necessary. + Enters demographics and UR information into claims or clinical management system; maintains data integrity. +...preferred. **Skills & Knowledge** + Knowledge of medical and insurance terminology + Knowledge of ICD9 and CPT coding… more