- CVS Health (Providence, RI)
- …handle customer service inquiries and problems. Additional Responsibilities - Reviews pre-specified claims or claims that exceed specialist adjudication ... day. **Position Summary** Reviews and adjudicates complex, sensitive, and/or specialized claims in accordance with plan processing guidelines. Acts as a subject… more
- CVS Health (Providence, RI)
- …Review and adjust SF (self-funded), FI (fully insured), Reinsurance, and/or RX claims ; adjudicates complex, sensitive, and/or specialized claims in accordance ... amount level on customer service platforms by using technical and claims processing expertise. + Applies medical necessity guidelines, determine coverage, complete… more
- Elevance Health (Smithfield, RI)
- …Coding Auditor Principal is responsible for auditing inpatient medical records on claims paid based on Diagnostic Relation Group (DRG) methodology, including case ... and per diem, generating highly complex audit findings recoverable claims for the benefit of the Company, for all...may be so complex and advanced that disputes or appeals may only be reviewed by other DRG Coding… more
- Cardinal Health (Providence, RI)
- …skills and prioritizes getting the right things done. **The Accounts Receivable Specialist II is responsible for processing insurance claims and billing. ... the appropriate system. + Manages and resolves complex insurance claims , including appeals and denials, to ensure...day with myFlexPay + Flexible spending accounts (FSAs) + Short - and long-term disability coverage + Work-Life resources +… more
- Cognizant (Providence, RI)
- …work collaboratively with stakeholders and other teams. The Accounts Receivable Specialist role responsibilities include following up directly with payers to resolve ... variances and take action to resolve accounts including drafting and submitting technical appeals . **In this role, you will:** - Be responsible for root cause… more