- Humana (Trenton, NJ)
- …a part of our caring community and help us put health first** The Appeals Representative 4 Investigates and resolves member and practitioner issues. manages ... determine if an a grievance, appeal or further request is warranted. The Appeals Representative 4 + Review documents + Building cases + Inventory Management +… more
- Humana (Trenton, NJ)
- …of our caring community and help us put health first** The Grievances & Appeals Representative 3 manages client denials and concerns by conducting a ... with clinical and other Humana parties. The Grievances & Appeals Representative 3 performs advanced administrative/operational/customer support duties… more
- Point32Health (NJ)
- …(https://www.point32health.org/) . **Job Summary** Under the general direction of the Member Appeals and Grievance Supervisor the Appeals and Grievance Analyst ... the professional and compliant management and coordination of assigned member appeals and grievance (complaints) received by Point32Health. This individual works… more
- Intermountain Health (Trenton, NJ)
- …such as debits/credits, required + Experience with insurance claim appeals , required + Excellent computer skills (including Microsoft Office applications), ... required- Familiarity with electronic remittances, required **Physical Requirements** + Interact with others by effectively communicating, both orally and in writing + Operate computers and other office equipment requiring the ability to move fingers and hands… more
- Cardinal Health (Trenton, NJ)
- …the appropriate system. + Manages and resolves complex insurance claims, including appeals and denials, to ensure timely and accurate reimbursement. + Processes ... denials & rejections for re-submission (billing) in accordance with company policy, regulations, or third-party policy. + More challenging claim cases + Investigates and updates the system with all information received from secondary insurance companies. +… more
- Highmark Health (Trenton, NJ)
- …of benefit billing practices through paid clams review. + Participate as pharmacy representative in onsite member appeals and grievances sessions. + Serve as ... a resource for technical staff. + Other duties as assigned or requested. **QUALIFICATIONS:** **Minimum** + High school diploma or GED + Experience in pharmacy prescription claims processing/submission/payment. **Preferred** + Associate degree + Pharmacy… more
- Highmark Health (Trenton, NJ)
- …correspondence inquiries (routine, priority Congressional / Department of Defense), and appeals . Ensures that all processes are compliant with requirements and ... Provides direction for priority Congressional and Department of Defense inquiries and appeals . + Performs administration tasks such as leave approvals and functions… more
- Intermountain Health (Trenton, NJ)
- …updates to charging/coding/NCCI regulations and/or errors, and regarding audits and appeals , to facilitate corrective action planning for improved processes. 7. ... experience leading others or leading project or programs. Certified Revenue Cycle Representative (CRCR) Certification completed within 3 months of hire. Plus one of… more
- Advanced Orthopedics and Sports Medicine Institute (Freehold, NJ)
- …time ( on -site ) Monday - Friday The AR Billing and Collection Representative II is responsible for analyzing assigned past due accounts and coordinating between ... parties to resolve payment discrepancies and delayed payments. The AR/Collection representative II core responsibility includes but not limited to minimizing… more
- CVS Health (Trenton, NJ)
- …providing support to both the employees and the customer Total Rewards team on appeals . + Assist the Total Rewards team with the administration of the customer ... health as evidenced through Data Analytics. + Assists the customer's Wellness Representative (s) in managing all aspects of the wellness program, including but not… more