- Prime Therapeutics (Columbus, OH)
- …decision we make. **Job Posting Title** Medicare Health Plan Operations Specialist - Remote **Job Description** The Associate Functional Business Consultant ... experience in at least one of the specific areas for position (eg, claims , eligibility, product, benefits, implementations or area related to the department with… more
- BrightSpring Health Services (Taunton, MA)
- …billing to eliminate financial risks + Researches, analyzes and appropriately resolves rejected claims by working with national Medicare D plans, third party ... and top-quality care come join our team and apply today! Responsibilities TheClaims Specialist - 3rd Party: + Manages and identifies a portfolio of rejected pharmacy… more
- Medical Mutual of Ohio (Brooklyn, OH)
- **_The Claims /Customer Care Specialist - TPA position allows you the flexibility to work at home as long as you reside within a 50-mile radius of the Brooklyn, ... self-funded group coverage, including stop loss, as well as Medicare Advantage, Medicare Supplement and individual plans....training and experience. . 2 years' experience as a Claims /Customer Care Specialist or equivalent customer service… more
- Montrose Memorial Hospital (Montrose, CO)
- …+ The Claims Analyst III must know the essential functions of denied claims for Medicare , Medicaid and Commercial payers for accurate payments of services ... portals. All About You : + High school diploma or equivalent; Associate degree preferred. + AAHAM(American Association of Hospital Administrative Management) CRCS… more
- Elevance Health (Louisville, KY)
- **Recovery Specialist Associate ** **Location** : Louisville, KY - Waukesha, WI - Indianapolis, IN **Hours:** 7:30 am - 4:00 pm CST / 08:30 am - 5:00 pm EST ... **may** require you to come into the office **periodically** ** The **Recovery Specialist Associate ** is responsible for identifying and initiating third-party /… more
- Conduent (Los Angeles, CA)
- … Specialist ** **Pay $18-20hr based on experience** The Insurance/Collections Specialist is responsible for analyzing medical claims data, seeking ... timely, maximum call time is achieved, and ensures quality results. Insurance-Collections Specialist will handle the collection/recovery of medical claims with… more
- Elderwood (Buffalo, NY)
- …The Pharmacy Billing Specialist is responsible for electronic billing of Medicare , Medicaid and Third Party Insurance claims , utilizing Frameworks LTC ... Pharmacy Billing Specialist Responsibilities: + Electronic billing of Medicare , Medicaid and Third Party Insurance claims utilizing Framework… more
- LA Care Health Plan (Los Angeles, CA)
- Coordination of Benefits Validation Specialist II Job Category: Administrative, HR, Business Professionals Department: Claims Integrity Location: Los Angeles, ... that purpose. Job Summary The Coordination of Benefits (COB) Validation Specialist ensures the accurate coordination of healthcare benefits for individuals covered… more
- Northern Light Health (South Portland, ME)
- …in customer accounts and billing. + Knowledge of requirements of the Centers for Medicare & Medicaid Services (CMS) claims forms; CMS-1500 and CMS-1450 (UB04). + ... Week: 40.00 Work Schedule: 8:00 AM to 4:30 PM Summary: The Billing Specialist is responsible for coordination of and participation in the billing and reimbursement… more
- LA Care Health Plan (Los Angeles, CA)
- Care Management Specialist II Job Category: Clinical Department: Care Management Location: Los Angeles, CA, US, 90017 Position Type: Full Time Requisition ID: 10945 ... safety net required to achieve that purpose. Job Summary The Care Management Specialist II utilizes clinical skills and training to perform essential functions of… more
- Medical Mutual of Ohio (OH)
- …insured and self-funded group coverage, including stop loss, as well as Medicare Advantage, Medicare Supplement, and individual plans. Under general supervision, ... Performs other duties as assigned. **Qualifications** Education and Experience . Associate degree in business administration or related field or equivalent… more
- LA Care Health Plan (Los Angeles, CA)
- Customer Solution Center Appeals and Grievances Specialist II Job Category: Customer Service Department: CSC Appeals & Grievances Location: Los Angeles, CA, US, ... purpose. Job Summary The Customer Solution Center Appeals and Grievances (A&G) Specialist II will receive, investigate and resolve member and provider complaints and… more
- Trinity Health (Howell, MI)
- …for the purpose of establishing the patient and service specific record for claims processing and maintenance of an accurate electronic medical record. Registers and ... information system(s), to ensure accurate and timely submission of claims . Determines visit-specific co-payments and collects out-of-pocket liabilities. Assists… more
- Emanate Health (Covina, CA)
- …oversight of HCC Program and STAR measures coding related functions. The HCC coding specialist will work with the IPA Director, Health Plan, and MSO personnel on HCC ... or improves upon 4.0 STAR rating. The HCC coding specialist is responsible for education to external physician offices...ensure the appropriate ICD10 and CPT codes submitted for Medicare and Covered CA lines of business. HCC Coding… more
- Trinity Health (Howell, MI)
- …for the purpose of establishing the patient and service specific record for claims processing and maintenance of an accurate electronic medical record. Registers and ... information system(s), to ensure accurate and timely submission of claims . Determines visit-specific co-payments and collects out-of-pocket liabilities. Assists… more
- LA Care Health Plan (Los Angeles, CA)
- Utilization Management Nurse Specialist LVN II Job Category: Clinical Department: Utilization Management Location: Los Angeles, CA, US, 90017 Position Type: Full ... to achieve that purpose. Job Summary The Utilization Management Nurse Specialist LVN II will facilitate, coordinate and approve medically necessary referrals… more
- LA Care Health Plan (Los Angeles, CA)
- Utilization Management Nurse Specialist RN II Job Category: Clinical Department: Utilization Management Location: Los Angeles, CA, US, 90017 Position Type: Full Time ... to achieve that purpose. Job Summary The Utilization Management Nurse Specialist RN II will facilitate, coordinate, and approve medically necessary referrals… more
- New York State Civil Service (Albany, NY)
- NY HELP No Agency Health, Department of Title Medical Assistance Specialist 1 - 79640 Occupational Category Other Professional Careers Salary Grade 18 Bargaining ... with permanent or contingent-permanent status as a Medical Assistance Specialist 1; OR current NYS employee with one year...Either 1: Six years of qualifying experience;Or 2: an Associate 's degree AND four years of qualifying experience;Or 3:… more
- Highmark Health (Columbus, OH)
- …Plan and its beneficiaries enrolled in risk-adjusted government programs such as Medicare Advantage (MA) and Affordable Care Act (ACA) through Hierarchical Condition ... (HCC) coding, medical coding, clinical terminology and anatomy/physiology, Centers for Medicare and Medicaid Services (CMS) coding guidelines, and support of Risk… more
- Sevita (Raleigh, NC)
- …a company that positively impacts the lives of others? In the AR Collections Specialist role, you will contribute to the company's commitment to serve others by ... sending claims to the payer in a timely and accurate...needed Qualifications: + High school diploma or equivalent required; Associate or Bachelor's degree preferred + 2-3 years of… more