- CareFirst (Fairfax, VA)
- …leadership. **Knowledge, Skills and Abilities (KSAs)** + Knowledge of call center operations claims and/or enrollment and billing and workflows. + Strong ... support, client services, client administration, customer service, enrollment and eligibility, claims processing, and call center operations . Investigates and… more
- Chesapeake Regional Healthcare (Chesapeake, VA)
- …(Palmetto GBA) and CMS web sites + Understanding of the CMS Publication: 100-4 ( Medicare Claims Processing Manual) + Ensures claim information is complete and ... limited as other tasks may be assigned. + Submit Medicare / Medicare Advantage plan claims both...deemed necessary by management , to ensure efficient department operations + Report potential or identified problems with systems… more
- Elevance Health (Norfolk, VA)
- …Experience processing claims with CI&W (WGS) preferred. + Healthcare commercial claims operations experience preferred. + JAA experience preferred. Please be ... **Financial Operations Recovery Specialist II** **Location:** Virtual/remote opportunity. The...responsible for the discovery, validation, recovery, and adjustments of claims overpayments. May do all or some of the… more
- Humana (Richmond, VA)
- …role should have critical thinking/problem solving skills, understanding of health plan operations , and strong interpersonal skills. + Serve as primary relationship ... manager with assigned skilled nursing facility providers to ensure...where necessary, collaboration with appropriate enterprise business teams (ex., claims payment, prior authorizations & referrals) + Work with… more
- Humana (Richmond, VA)
- …They will work closely with IT, the pricing software vendor, CIS BSS, Medicaid operations , claims operations , and other business teams involved in the ... APR-DRG and/or EAPG grouper logic + Experience processing or reviewing facility claims + Prior professional experience utilizing Microsoft Excel (eg performing basic… more
- Chesapeake Regional Healthcare (Chesapeake, VA)
- …emergency department, and outpatient diagnostic records as determined by Coding Operations Manager + Consistently maintain established productivity requirements ... procedures by following the ICD, Uniform Hospital Data Set, Medicare , Medicaid, and other fiscal Intermediary guidelines + Work...submission + Assist the Coding Compliance Specialist and/or Coding Operations Manager as needed + Fill-in for… more
- Chesapeake Regional Healthcare (Chesapeake, VA)
- …emergency department and outpatient diagnostic records as determined by Coding Operations Manager . + Consistently maintain established productivity requirements ... diagnoses and procedures by following the ICD, Uniform Hospital Data Set, Medicare , Medicaid, and other fiscal Intermediary guidelines + Work cooperatively with the… more
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