- University of Rochester (Rochester, NY)
- …Documents all account follow up activity. + Research and calculate under or overpaid claims ; determine final resolution + Review and determine correct follow up. ... + Adjust account or process insurance refund credits. + Review and advise supervisor or manager of...supervisor or manager of trends on incorrectly paid claims from specific payers. + Work with supervisor… more
- Excellus BlueCross BlueShield (Rochester, NY)
- …Assesses staff and unit training needs and reports this information to the supervisor . + Collaborates with other key departments ( Claims , Customer Service, ... and related health plan functions such as member services, claims , and the referral process. As well as functions...to the Health Plan Essential Accountabilities: Level I + Review / prep clinical case for clinical staff. +… more
- Beth Israel Lahey Health (Charlestown, MA)
- …all Hospital Billing, Follow-Up, and Denial activities necessary to obtain payment/resolution of claims .** ** Review the entire account to ensure claims were ... all claims /data problems that cannot be handled to the Supervisor /Manager within one (1) day of identifying the problem.** **Identifies and researches… more
- Beth Israel Lahey Health (Charlestown, MA)
- …all Hospital Billing, Follow-Up, and Denial activities necessary to obtain payment/resolution of claims . * Review the entire account to ensure claims ... to: * Utilizes the Epic Hospital Billing System to review and monitor accounts through the Billing, Denial, &...claims /data problems that cannot be handled to the Supervisor /Manager within one (1) day of identifying the problem.… more
- University of Southern California (Alhambra, CA)
- …the updates; requests rebills as necessary. Submits adjustment requests to immediate Supervisor for review and approval. Applies proficiency in understanding and ... folder notes. Uses appropriate collector comment codes. + Meets Production and Quality Review Standards set by Team Supervisor and Billing Manager. Reviews… more
- Whitsons Culinary Group (Islandia, NY)
- …Specialist is responsible for managing the end-to-end workers' compensation claims process, ensuring timely, accurate, and cost-effective resolution of all ... claims . This role serves as the primary liaison between...that require escalation, intervention, or additional medical or legal review . Cost Control & Risk Mitigation + Actively manage… more
- Sedgwick (Bartlesville, OK)
- …**PRIMARY PURPOSE:** To analyze complex or technically difficult workers' compensation claims to determine benefits due; to work with high exposure workers' ... compensation claims involving litigation and rehabilitation; to ensure ongoing adjudication...coding is correct. + Refers cases as appropriate to supervisor and management. + Leads team meetings and assigns… more
- Travelers Insurance Company (New York, NY)
- …evaluating, reserving, negotiating and resolving assigned serious and complex Specialty claims . Provides quality claim handling throughout the claim life cycle ... **What Will You Do?** + Directly handle assigned severe claims . + Full damage value for average claim (without...documentation tools in accordance with department guidelines. + Proactively review Claim File Analysis (CFA) for adherence to quality… more
- Stony Brook University (East Setauket, NY)
- …include the following, but are not limited to:** + Prepare and submit hospital claims . Review denials. Investigate coding issue. Audits. + Follow-up on rejected ... party billing and collection agencies. + Identify issues and patterns with claims /insurance companies and review to increase revenue and prevent unnecessary… more
- University of Rochester (Albany, NY)
- …as they pertain to claim processing and coding. Escalates system issues preventing claims submission and follow-up for review and resolution. + 5% Collaborates ... of the individual, and internal equity considerations._ **Responsibilities:** The Claims Resolution Representative III is responsible for working across the… more