- Humana (Pierre, SD)
- …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
- Intermountain Health (Pierre, SD)
- …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 (Pierre, SD)
- …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 (Pierre, SD)
- …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 (Pierre, SD)
- …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 (Pierre, SD)
- …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
- Avera (Sioux Falls, SD)
- …Responsible for aged accounts receivable (AR) follow up & denial review and appeals processes across assigned facilities at Avera. The Manager will develop and ... speech and other sounds. These requirements and those listed above are representative of the knowledge, skills, and abilities required to perform the essential… more
- Cardinal Health (Pierre, SD)
- …appropriate team member (when applicable) * Resolve patient's questions and any representative for the patient's concerns regarding status of their request for ... * Follow through on all benefit investigation rejections, including Prior Authorizations, Appeals , etc. All avenues to obtain coverage for the product must be… more
- Cardinal Health (Pierre, SD)
- …insurance plan coverage, including out-of-pocket costs, and provide guidance on the appeals process if needed + Resolve patient's questions and any representative ... for the patient's concerns regarding status of their request for assistance + Demonstrate expertise in payer landscapes and insurance processes. Remain knowledgeable about long and short-range changes in the reimbursement environment including Medicare,… more
- Avera (Brookings, SD)
- …of unpaid, overpaid/over adjusted and denied claims. + Reviews, analyzes, and appeals denials received relative to claims processing issues with insurance payers. + ... speech and other sounds. These requirements and those listed above are representative of the knowledge, skills, and abilities required to perform the essential… more