- Cognizant (Salem, OR)
- …to the Health Plan/Payer. The comprehensive process includes analyzing, reviewing, and processing medical necessity denials for resolution. You will be a valued ... accounts. + Maintain working knowledge of applicable health insurers' internal claims , appeals, and retro-authorization as well as timely filing deadlines and… more
- Elevance Health (Norfolk, VA)
- …and effectiveness of drugs and other biologic interventions. + Uses a large claims database to conduct studies which focus on improving health outcomes. + Leads ... models; 3 years coding experience with SAS; 3 years experience manipulating and processing large multi-source datasets with SAS and SQL programming tools; or any… more
- Healthfirst (FL)
- …and the Department of Financial Services (DFS). + Experience with or knowledge of claims processing and provider billing workflows. + Exposure to or direct ... processes and how service authorizations impact member access to care and claims payment + Proficient in Microsoft Office Suite, including Excel (sort, track… more
- TEKsystems (Wood Dale, IL)
- …to maintain strong customer relationships and fair and effective resolution of claims and complaints, in alignment with consumer laws. Key Responsibilities: -Deliver ... service across sales, promotions, and installation processes. -Resolve customer claims and complaints fairly and effectively. -Maintain positive customer relations… more
- Guidehouse (Atlanta, GA)
- …Lead quantitative analysis and modeling of real-world data, including CMS, commercial claims , and clinical health data, to generate actionable insights for federal ... Python, and SQL. + Utilize DataBricks and Snowflake for scalable data processing and analytics. + Collaborate with epidemiologists, clinicians, and public health… more
- State of Montana (Helena, MT)
- …parties involved in claims or third parties about cases, retrieving and processing records, and managing information related to HRB claims . * *Written and ... market increases and state statutory raises. * Health, dental, vision, life insurance coverage, flexible spending accounts, EAP - click hereto learn more. *… more
- Growth Ortho (Sioux Falls, SD)
- …includes billing, payment posting, denial resolution, A/R follow-up, and patient balance processing . While each specialist may focus on a primary area (Billing or ... Perform timely follow-up on outstanding A/R, including unpaid, underpaid, and denied claims across all payer types. Analyze EOBs and prepare effective appeals to… more
- Elevance Health (Dearborn, MI)
- …savings. + Consults with business partners concerning processes, procedures, contracts, processing rules and other system rules. + Collaborate on automation to ... validate claims overpayment. + Performs analyses of structured and unstructured...term disability benefits, 401(k) +match, stock purchase plan, life insurance , wellness programs and financial education resources, to name… more
- Highmark Health (Montpelier, VT)
- …+ High school diploma or GED + Experience in pharmacy prescription claims processing /submission/payment. **Preferred** + Associate degree + Pharmacy technician ... medication requests, and drug claim edits/prior authorizations. By reviewing member claims history, clearly defines the medical necessity of non-formulary and prior… more
- Elevance Health (Seattle, WA)
- …+ Performs in-depth investigations on identified providers as warranted. + Examines claims for compliance with relevant billing and processing guidelines and ... fraud and abuse prevention and control. + Review and conducts analysis of claims and medical records prior to payment. Researches new healthcare-related questions as… more