- Highmark Health (Providence, RI)
- …charges. The incumbent will also conduct or assist with provider and subscriber investigations to verify the validity of services and charges; will monitor internal ... facility and professional provider over-payments. + Investigation Support: Assist with investigations : Assist in the interviews of customers and providers to obtain… more
- CVS Health (Cumberland, RI)
- …11:30 PM - 8:00 AM. **Position Summary** CVS Health is seeking a CAS Alarm Dispatch Coordinator to join our team. As a CAS Alarm Dispatch Coordinator , you will ... compliance of security alarm systems and frequent communications for active investigations of organized retail crime. + Maintain alarm processing database. (Call… more
- Cardinal Health (Providence, RI)
- …of applicable regulations, standards, and operating procedures. + Conduct investigations /root cause analysis and formulate corrective action recommendations. + Show ... an understanding of the program requirements and be capable of conducting gap assessments based on those requirements. + Uphold quality standards that adhere to company, regulatory, and HIPAA policies and procedures. + Collaborate across various functions,… more
- Cardinal Health (Providence, RI)
- …regulations, standards and operating procedures. + Demonstrates ability to perform investigations / root cause analysis and develop corrective actions. + ... Demonstrates an understanding of the requirements and has the ability to perform gap assessments to those requirements. + Demonstrates an understanding of quality concepts such as: cost of quality, analytical metrics and / or statistics, trending, quality… more
- Cardinal Health (Providence, RI)
- …+ Experience conducting and documenting patient health insurance benefit investigations , prior authorizations, and appeals, preferred (2+ years) + Knowledge ... of Medicare, Medicaid and Commercially insured payer common practices and policies, preferred + Critical and creative thinking, preferred + Knowledge of Medical/Pharmacy billing and coding, preferred + Strong attention to detail is vital + Bilingual, preferred… more
- Cardinal Health (Providence, RI)
- …regulations, standards, and operating procedures. + Demonstrates ability to perform investigations / root cause analysis and develop corrective actions. + ... Demonstrates an understanding of the requirements and has the ability to perform gap assessments to those requirements. + Demonstrates an understanding of quality concepts such as: cost of quality, analytical metrics and / or statistics, trending, quality… more
- Prime Therapeutics (Providence, RI)
- …recommendations. + MISCELLANEOUS DUTIES: + Provide backup support to team members (SIU Coordinator and Senior SIU Specialist) in the performance of job duties as ... + Education Level Bachelors + Experience Level 2+ years + Required Fraud Investigations and Claims experience Must be eligible to work in the United States… more
- CVS Health (Cumberland, RI)
- …+ Monitor the team's performance by performing quarterly Matrix evaluations with each coordinator on their team. + Trains and Develop Alarm Coordinators on various ... ensure compliance of security alarm systems and frequent communications for active investigations of organized retail crime. + Responds to inbound security alarm… more
- State of Massachusetts (Franklin, MA)
- …as required. May also serve as a back-up to a Probation Case Coordinator . *Duties:* Probation Case Specialist I Duties: Provides customer service to attorneys, ... Officers, including typing case folders, violation hearing notices, pre-sentence investigations , probation transfers, letters, reports, and other non-standard documents… more