- Humana (Springfield, IL)
- …and quality related topics. + Educate on processes including claims submissions, recoupments, reconsiderations, authorizations, referrals, medical record ... limits. **Preferred Qualifications** + Bachelor's Degree. + Understanding of claims systems, adjudication , submission processes, coding, and/or dispute… more
- Banner Health (Phoenix, AZ)
- … claims typically acquired over one to two years of work experience in medical claims adjudication , contract interpretations, billing and coding, and ... and extend our innovation to employment settings by including remote and hybrid opportunities. As a **Provider Experience Representative**...staff members. You will call upon your **background in medical billing, medical claims , customer… more
- Healthfirst (NY)
- …investigation, determination and reporting of financial processes** **_specifically around Healthcare Claims Adjudication and Claims Processing_** + ... **This position is 100% Remote .** **Scope of Responsibilities:** + **Conduct moderately complex...the quality of the network.** + **Review and investigate claims and encounters for medical , facility, pharmacy,… more
- Veterans Affairs, Veterans Health Administration (Harlingen, TX)
- …Care System (VATVCBHCS). Maintains responsibility for processing Beneficiary Travel Claims utilizing the Computerized Patient Record System (CPRS), Veterans Health ... for determining method of payment for authorized and unauthorized ambulance claims submitted for consideration. . Reconciling vouchers against authorizations for… more
- Humana (Oklahoma City, OK)
- …providers (eg, provider relations, claims education) + Understanding of claims systems, adjudication , submission processes, coding, and/or dispute resolution ... issues with appropriate enterprise business teams, including those associated with claims payment, prior authorizations, and referrals, as well as appropriate… more
- Blue Cross and Blue Shield of Minnesota (Eagan, MN)
- …policies are implemented and integrated in all systems for accurate claims adjudication . This includes analysis of changes to medical code sets to determine ... 3 years of relevant health plan or provider office medical coding/ claims and/or Business Analyst experience in...rest of the week you are empowered to work remote . Equal Employment Opportunity Statement Individuals with a disability… more
- Cognizant (Phoenix, AZ)
- …of experience to join our dynamic team. Your expertise in Medicare and Medicaid Claims will be crucial in ensuring efficient processing and management of claims . ... * Provide technical expertise in the Medicare and Medicaid Claims , Claims , and Payer domains. - Collaborate...skills. * Experience in development in RxCLAIM application ( Adjudication ) is STRONGLY PREFFERRED. * Should be able… more
- US Tech Solutions (Columbia, SC)
- …in data collection/input into system for clinical information flow and proper claims adjudication . + Demonstrates compliance with all applicable legislation and ... Hours/Schedule - Monday-Friday, 8:30am-5pm. + Onsite training for first 1-2 weeks then remote training. + Reviews and evaluates medical or behavioral eligibility… more
- Humana (Frankfort, KY)
- …contracts, including contract language and reimbursement. + Comprehensive knowledge of claims systems, adjudication , submission processes, coding, and/or dispute ... issues with appropriate enterprise business teams, including those associated with claims payment, prior authorizations, and referrals, as well as appropriate… more
- InGenesis (Columbia, SC)
- …and assess and monitor medical necessity using your clinical proficiency and claims knowledge. This is a REMOTE opportunity for candidates living in the ... SC. In this role you will review and evaluate medical or behavioral eligibility regarding benefits and clinical criteria...collection/input into system for clinical information flow and proper claims adjudication * Perform other duties as… more