- US Tech Solutions (Myrtle Beach, SC)
- … and completes adjustments and related reprocessing actions. Reviews and adjudicates claims and/or non- medical appeals. Determines whether to return, deny or ... according to department guidelines. **Responsibilities:** + Examines and processes claims and/or non- medical appeals according to business/contract regulations,… more
- Sedgwick (Raleigh, NC)
- …**ESSENTIAL FUNCTIONS and RESPONSIBILITIES** + Performs standard clinical reviews of referred medical claims based on client requirements to ensure accurate and ... Disability Clinical Specialist **PRIMARY PURPOSE** : Performs standard clinical evaluations on claims that require additional review based on medical condition,… more
- Excellus BlueCross BlueShield (Rochester, NY)
- …experience with ICD 10CM, MS-DRG, and APR-DRG with a broad knowledge of medical claims billing/payment systems, provider billing guidelines, medical ... with ICD 10CM, MS-DRG, and APR-DRG with a broad knowledge of medical claims billing/payment systems, provider billing guidelines, medical necessity criteria,… more
- Kelly Services (Myrtle Beach, SC)
- …including telephone, written, web, or walk-in inquiries. + Reviewing and adjudicating claims and/or non- medical appeals, determining whether to return, deny, or ... opportunities are right here in your backyard. Kelly(R) is looking for a Claims Customer Service Representative to work at a premier organization in Myrtle Beach,… more
- KPH Healthcare Services, Inc. (Syracuse, NY)
- …Summary:** Responsible for developing, improving and continuing the process billing of medical claims for specialty pharmacy facilities. Needs to communicate ... assigned tasks. Establish, manage, and communicate the process of billing medical claims for specialty facilities. **Responsibilities** **Job Duties:** +… more
- Zelis (St. Petersburg, FL)
- …members achieve more favorable financial outcomes. What you will do: + Analyze medical claims submitted by members along with their Explanation of Benefits ... you'll bring to Zelis: + Bachelor's Degree + 5+ years of medical claims & member benefit application experience + Strong analytical and problem-solving skills… more
- TEKsystems (Hamden, CT)
- …skills,Customer service Additional Skills & Qualifications Prepare and submit accurate medical claims to insurance companies and third-party payers. Review ... Description The Medical Billing Specialist is responsible for managing patient...is responsible for managing patient billing processes, submitting insurance claims , and ensuring accurate and timely reimbursement for healthcare… more
- Sedgwick (Miami, FL)
- …properly documented and claims coding is correct. + May process complex lifetime medical and/or defined period medical claims which include state and ... remote GL Adjuster role puts you at the center of resolving complex claims with flexibility and autonomy. **PRIMARY PURPOSE:** To analyze mid- and higher-level… more
- Humana (San Juan, PR)
- …coding certification from the AAPC and/or AHIMA) + Extensive knowledge of medical claims processing and familiarity with reimbursement methodologies, ICD, CPT, ... BS in healthcare or business-related field + Knowledge of internal Medical Coverage Policies and Claims Payment Policies + CAS claims processing experience +… more
- Houston Methodist (Houston, TX)
- …AR collections. **FINANCE ESSENTIAL FUNCTIONS** + Expedites and maximizes payment of insurance medical claims by contacting third party payers and patients. This ... responsible for resolving all outstanding third-party primary and secondary insurance claims for professional services. This Specialist is required to perform… more