- The Institute for Family Health (New Paltz, NY)
- …years of medical billing experience required + Proficiency in EPIC claims processing workflows preferred + Ability to run and interpret/analyze Crystal and EPIC ... CYCLE COORDINATOR Job Details Job Location New Paltz Family Health Center - New Paltz, NY Position Type Full...of denials are at optimal levels + Ensure daily/weekly/monthly medical claim submission. Resolve claim and remittance file issues… more
- Molina Healthcare (Warren, MI)
- …to providers. **Job Duties** + Performs clinical/ medical reviews of retrospective medical claim reviews, medical claims and previously denied cases, ... documentation for denial and modification of payment decisions + Independently re-evaluates medical claims and associated records by applying advanced clinical… more
- Excellus BlueCross BlueShield (Buffalo, NY)
- …implementation of recommendations to providers that would improve utilization and health care quality. Reviews claims involving complex, controversial, or ... to apply! Job Description: This position assists the Chief Medical Director to direct and coordinate the medical...for business continuity. + Ability to travel across the Health Plan service region for meetings and/or trainings as… more
- Hawaii Pacific Health (Lihue, HI)
- …In this role, you will review patients' available data, including clinical/ claims history, outpatient treatments, medications, medical benefits from electronic ... skills and a commitment to delivering the highest quality health care to Hawai'i's people. Location: Kauai Medical... health care to Hawai'i's people. Location: Kauai Medical Clinic, Lihue, HI **Work Schedule:** Day - 8… more
- Haleon (Warren, NJ)
- …as member of the NA RDLT and is responsible for driving growth through medical and scientific affairs innovation, claims development, and setting direction to ... **Hello** . We're **Haleon** . A new world-leading consumer health company. Shaped by all who join us. Together,...unlock next generation capabilities. As the Head of Medical and Scientific Affairs for North America, you will… more
- CVS Health (Hartford, CT)
- …licensure a plus. **Preferred Qualifications:** Previous Experience in Utilization Management / Claims Determination with another Health Plan / Payor or Hospital ... At CVS Health , we're building a world of health ...services to its membership. Aetna is looking for a medical director to be part of a centralized team that… more
- Veterans Affairs, Veterans Health Administration (Bay Pines, FL)
- …Education Experience. One year of creditable experience that indicates knowledge of medical terminology and general understanding of health records. Six months ... Code (USC) | 552a; Department of Veterans Affairs (VA) Claims Confidentiality Statute, 38 USC | 5701; Confidentiality of...of 12 semester hours in health information technology/ health information management (eg, courses in medical … more
- LA Care Health Plan (Los Angeles, CA)
- …relevant coding elements. Audits can include inpatient, outpatient, and professional claims . Serves cross functionally with Utilization Management, Medical ... insurance business, industry terminology, and regulatory guidelines. Working knowledge of claims coding and medical terminology. Solid understanding of standard… more
- Elevance Health (Cincinnati, OH)
- … Specialties (ABMS) or American Osteopathic Association (AOA). + Requires active unrestricted medical license to practice medicine or a health profession. + ... **Clinical Compliance Medical Director** _Please note that per our policy...claims strongly preferred. Please be advised that Elevance Health only accepts resumes for compensation from agencies that… more
- WellSpan Health (Chambersburg, PA)
- Position Function: Under the direction of the Coding Manager, functions as a medical coder for the Health Information Management Department to review, retrieve, ... as required. 5. Completes hospital-required reviews, eg, HIPAA, safety, health screening, care concerns, and others as assigned. 6. Adheres… more