- Trinity Health (Farmington Hills, MI)
- …and non-government accounts. The position reports directly to the Supervisor Billing and Follow-up. **ESSENTIAL FUNCTIONS** Knows, understands, incorporates, and ... of the revenue cycle process for an assigned PBS location. Documents claims billed, paid, settled, and follow-up in appropriate system(s). Identifies and escalates… more
- Arab Community Center for Economic and Social Serv (Dearborn, MI)
- Supervisor , Office Administration Department: Community Health & Research Center Location: Dearborn, MI START YOUR APPLICATION ... (https://apply.hrmdirect.com/resumedirect/ApplyOnline/Apply.aspx?req\_id=2992786&source=2992786-CJB-0) Job Title: Supervisor , Office Administration Job Status: Full-time Functional areas employee… more
- DOCTORS HEALTHCARE PLANS, INC. (Coral Gables, FL)
- Not a Remote Position-Only Local Applicants The Clinical Data Analyst is accountable to use their knowledge of data processing software and business development ... business initiatives' success. With strong communication and organizational skills, the claims data analyst assists leadership and team in achieving goals,… more
- UCLA Health (Los Angeles, CA)
- …and complex patient/provider issues related to the authorization and claims process. You will also conduct performance evaluations, counsel employees, and take ... and key performance indicators. You will hire and train non- clinical coordinator staff as well as manage and monitor...We're also home to the world-class medical research and clinical education capabilities of the David Geffen School of… more
- CVS Health (Frankfort, KY)
- …make health care more personal, convenient and affordable. Position Summary: The Complex Nurse Case Manager is responsible for assessing members through regular and ... Services strategies policies and programs are comprised of network management and clinical coverage policies. This is a field-based position that requires routine… more
- University of Rochester (Rochester, NY)
- …accounts in order to bring about prompt account resolution and revenue collection from complex claims , high dollar claims and specialized services (global ... Service Representatives. **15% Designated Support** + Researches and responds to SMH clinical department inquiries on complex , high dollar and specialized… more
- Trinity Health (Farmington Hills, MI)
- …location. The scope of responsibility will be all post-billed denials (inclusive of clinical denials). Serves as part of the Payment Resolution team at an assigned ... variances from expected reimbursement, and resolving or escalating issues to the Supervisor Payment Resolution for resolution. This position reports directly to the … more
- Trinity Health (Farmington Hills, MI)
- …problem resolution as needed. This position reports directly to a Supervisor Billing & Follow-Up. **ESSENTIAL FUNCTIONS** Knows, understands, incorporates, and ... of the revenue cycle process for an assigned PBS location. Documents claims billed, paid, settled, and follow-up in appropriate system(s). Identifies and escalates… more
- Houston Methodist (Houston, TX)
- …Service Standards. **PEOPLE ESSENTIAL FUNCTIONS** + Collaborates with management to target complex claims and reduce aging of accounts by providing verbal ... responsible for resolving all outstanding third-party primary and secondary insurance claims for professional services. This Specialist is required to perform… more
- Apex Health Solutions (Houston, TX)
- Job Title: UM Analyst Department: Medical Management Supervisor (s): UM Supervisor or Manager of Medical Management Summary Utilization Management (UM) Analyst ... role is key in collaborating with other departments to ensure appropriate claims adjudication and delivery of excellent customer service. UM Analyst also… more
- Albany Medical Center (Albany, NY)
- Department/Unit: Clinical Chemistry Work Shift: Weekend_Night (United States of America) Salary Range: Min. $31.28/hr - Max $51.61/hr The Clinical Technical ... new test methodologies and procedures. This individual may also serve as a qualified supervisor in the absence of the Laboratory Supervisor and Assistant … more
- CVS Health (Springfield, IL)
- …Call insurance plans to follow-up on submitted prior authorizations. * Communicate to the Supervisor staff and then escalate to the Claims Manager any changes in ... been an Omnicare specialty, we also serve other targeted populations. The CIC, Claims associate is responsible for the timely and accurate distribution of phone… more
- Guthrie (Sayre, PA)
- …Billing Specialists I and related support staff. Works closely with Director, Manager, Supervisor and Application Analyst on day to day priorities and to maintain a ... within the unit. Takes the necessary action to complete all types of complex insurance billings and appeals. Reviews and analyzes the insurance processing procedures… more
- MD Anderson Cancer Center (Houston, TX)
- …billing (hospital and physician) and the ability to review and explain how claims processed according to the Explanation of Benefits. This individual needs to be ... the guidance of the Patient Business Center Customer Service Supervisor and will be responsible for timely escalation of...resolution. **Key Functions** 1. Manages a high volume of complex inquiries in EPIC and resolves concerns within 24-48… more
- Crawford & Company (Houston, TX)
- …Compensation, Group Health, Liability and Disability. Responsibilities + May assist supervisor /manager in review of reports, staff development. + Reviews case ... goals to include RTW. + May review files for claims adjusters and supervisors. + May perform job site...employers to review active files. + Reviews cases with supervisor monthly to evaluate file and obtain direction. +… more
- The Cigna Group (Bloomfield, CT)
- …related issues, implications and decisions. The Appeals Reviewer reports to the Supervisor /Manager of Appeals and will coordinate and perform all appeal related ... + Review, research and understand how request for plan services and claims submitted by consumers (members) and physicians/providers was processed and determine why… more
- Houston Methodist (Houston, TX)
- …for resolving all outstanding third party primary and secondary insurance claims for professional services. This position performs collections activities on simple ... and complex denials and on outstanding insurance balances in the...and written communication. + Identifies denial trends and notifies supervisor and/or manager to prevent future denials and further… more
- Houston Methodist (Houston, TX)
- …for resolving all outstanding third party primary and secondary insurance claims for professional services. This position performs collections activities on simple ... and complex denials and on outstanding insurance balances in the...written communication. (EF) 2. Identifies denial trends and notifies supervisor and/or manager to prevent future denials and further… more
- Rush University Medical Center (Chicago, IL)
- …& Credits, adjustments, refunds, and claim corrections resulting from the multitude of claims and payer edits as well as notifying denial management of audits. ... collected in accordance to contract allowable payment schedule. 2. Follow up on claims with the appropriate payer for reimbursement. 3. Work directly with various… more
- East Boston Neighborhood Health Center (East Boston, MA)
- …care to SCO (Senior Care Options) providers for their psychiatrically complex patients, consistent with experience. Demonstrates excellent clinical judgement ... be required to demonstrate age specific competency, depending upon clinical assignment, in a variety of clinical ...known risk factors. Serves as an expert consultant and/or supervisor to PACE providers (Program of All-Inclusive Care of… more