- TEKsystems (Honolulu, HI)
- At TEKsystems we are working with a local company seeking a Claims Manager will oversee the claims processing operations, ensuring accuracy, efficiency, and ... skills, and the ability to drive process improvements. The Claims Manager will manage both onshore and...or related field. Master's degree preferred. + Must have Medicare /Medicaid claims process knowledge + Leadership -… more
- Select Medical (Camp Hill, PA)
- …benefits are exhausted. + Once patient determined to be Medicare Exhaust, specialist files Medicare part A and part B claims to Medicare . + Specialist ... are exhausted. Ensures all authorizations are obtained as necessary and sends claims to secondary (commercial/Medicaid) payers along with Medicare remittance… more
- Molina Healthcare (West Valley City, UT)
- …with the standards and requirements established by the Centers for Medicare and Medicaid **Knowledge/Skills/Abilities** * Leads, organizes, and directs the ... to members or authorized representatives in accordance with Centers for Medicare and Medicaid standards/requirements. * Provides direct oversight, monitoring and… more
- CVS Health (Hartford, CT)
- …in new and exciting ways every day. Aetna is currently seeking a **Senior Manager for the Test Center of Excellence** team. This individual will be responsible for ... regression testing, financial neutrality testing, and performance testing, across claims platforms. + Establish and monitor the ongoing capabilities required… more
- Elevance Health (Atlanta, GA)
- **Business Information Consultant - Vendor Medicare /Medicaid Encounter Data** **Location:** Norfolk, VA; Atlanta, GA; Tampa, FL; Indianapolis, IN; Cincinnati, OH ... procedures. + Develops and analyzes business performance reports (eg for claims data, provider data, utilization data) and provides notations of performance… more
- LA Care Health Plan (Los Angeles, CA)
- …by the Manager of Financial Compliance. These assignments may include claims data reporting in the Online Monitor Tool (OMT), compiling Monthly Timeliness Report ... Financial Compliance Auditor III Claims Job Category: Accounting/Finance Department: Financial Compliance Location:...for a variety of complex areas of the Medi-Cal, Medicare , Covered California, and PASC-SEIU benefit and process. This… more
- CHS (Clearwater, FL)
- …related to claims and calls and provides feedback to their Manager . + Maintains up-to-date working knowledge on regulatory requirements associated with billing ... **Overview** ** ** ** Claims and Call Auditor (Call Center QC) -...with accuracy, and work with the MPS Call Center Manager /Supervisor/Team Lead and analyze the data for training purposes.… more
- BrightSpring Health Services (Arlington, TX)
- …obtaining information completing necessary documentation or following up on outstanding claims + Individual with an understanding of Insurance and Medicaid ... as assigned + Achieves productivity goals with regard to calls/ claims per hour as determined by the Director and...hour as determined by the Director and Clinical Hub Manager + Provide clinical support to members of the… more
- Marshfield Clinic (Marshfield, WI)
- …to support the most exciting missions in the world!** **Job Title:** Claims Processor - Patient Financial Services **Cost Center:** 101651259 Prof Billing And ... 5:00 pm (United States of America) **Job Description:** **JOB SUMMARY** The Claims Processor-Patient Financial Services (PFS) investigates held claims . Resolves… more
- CenterWell (Topeka, KS)
- …+ Guide/instruct and support agency personnel encompassing all aspects of insurance and non- Medicare claims processing. + Prepare input data forms to update ... community and help us put health first** As an **RCM Healthcare Claims Denials Specialist/Accounts Receivable Specialist** , you will: + Ensure the coordination… more
- Guidehouse (El Segundo, CA)
- …**:** None **What You Will Do** **:** The **Billing Supervisor - Healthcare Claims ** is responsible for the daily operations of billing and works closely with ... processes. The Billing Supervisor reports directly to an Operations Manager or Director level position and may perform any...CPT, HCPCS and Revenue Codes. + Provide departments with Medicare and other payer updates, notices and coverage changes… more
- Blue Cross Blue Shield of Massachusetts (Hingham, MA)
- …pharmacy performance guarantees, security audits, and other Production Operations duties + Oversee Medicare Part D Claims audits to ensure that all MAPD and ... Reports to the Associate Director of Project Portfolio Management. The Program Manager of Production Operations will direct a Production Operations team supporting… more
- Masonicare (Wallingford, CT)
- … meeting, utilization review and monthly end of close meetings. + Assists with Medicare denial claims /reviews when need is identified by billing office. + Keeps ... RN Manager Clinical Reimbursement Job Location: Wallingford Center, Connecticut...relates to facility care practices + Manages the patient's Medicare benefit by communication of skilled needs to the… more
- Otsuka America Pharmaceutical Inc. (Providence, RI)
- **Position Summary** The Field Reimbursement Manager (FRM) serves as the subject-matter expert on reimbursement, access, and coverage issues for our products, ... and their staff on matters related to access, coverage, reimbursement processes, claims submissions, and coding requirements + Analyze payer criteria and provide… more
- LA Care Health Plan (Los Angeles, CA)
- Manager , Customer Solution Center Appeals and Grievances Job Category: Management/Executive Department: CSC Appeals & Grievances Location: Los Angeles, CA, US, 90017 ... net required to achieve that purpose. Job Summary The Manager , Customer Solution Center Appeals and Grievances is responsible...and grievances for all product lines (Medi-Cal, Medi-Cal Direct, Medicare , PASC-SEIU and LA Care Covered) in a manner… more
- BrightSpring Health Services (Englewood, CO)
- …through our growing network of branches and healthcare professionals. The Billing Manager will perform and supervise all activities related to the billing of ... all Accounts Receivable, including but not limited to, Medicare , Medicaid, commercial insurances, and patient balances. The Billing Manager will perform all… more
- Always Best Care Senior Services (San Diego, CA)
- …Clinical Manager Always Best Care Home Health is seeking a RN Clinical Manager with Medicare experience to guide, lead and build a fast growing, results ... oriented Home Health Agency. The Clinical Manager compliments the Administrator in planning, developing and supervising the activities of Licensed and non-licensed… more
- University of Rochester (Rochester, NY)
- …and adjudication, including refund of credits - - Review and advise supervisor or manager on trends of incorrectly paid claims from specific payers - - ... as to the processes necessary to collect denied insurance claims and resolve billing issues. Must track payer/billing issues...tasks, following standard procedures, and as directed by the Manager , Billing or Manager . Independent judgement is… more
- Walgreens (Schofield, WI)
- …policies inclusive of participating in the billing and submission of claims to government-sponsored health care programs, including Medicare , Medicaid, ... growing the business at the site. Performs all duties of the Pharmacy Manager in their absence **.** **Customer Experience** + Ensures that store personnel provide… more
- WesleyLife (Johnston, IA)
- **Description** WesleyLife is seeking a skilled Revenue Cycle Manager to lead our centralized reimbursement and billing team. This pivotal role is responsible for ... analysis. With a strong focus on operational excellence, the Revenue Cycle Manager will drive performance improvements and enhance revenue cycle outcomes across all… more