- WALGREENS (Port Angeles, WA)
- …generics, less expensive medicines, and over-the-counter products. Refers to the medical provider, as needed, to ensure medication is taken correctly, health ... productivity * Ensures insurance claims are processed accurately to prevent payment rejections. Resolves patient issues by working with insurance companies and… more
- WALGREENS (Lincoln, IL)
- …the accurate processing of insurance claims to resolve customer issues and prevent payment rejections. Follows-up with insurance companies as well as medical ... providers and conducts or participates in 3rd party audit. * Assists and supports Store Manager and Pharmacy Manager in analyzing and seeking to improve pharmacy financials, operational quality and customer service. * Manages Community Outreach Portal and… more
- Robert Half Office Team (Indianapolis, IN)
- Description Join our team as a Medical Payment Posting Specialist and make a direct impact on the financial success of leading healthcare organizations. In this ... payment posting and financial reporting. Requirements + Previous experience in medical payment posting or revenue cycle operations preferred + Knowledge of… more
- Humana (Carson City, NV)
- …a part of our caring community and help us put health first** The Medical Director actively uses their medical background, experience, and judgement to make ... reference materials, internal teaching conferences, and other reference sources. Medical Directors will learn Medicare, Medicaid, and Medicare Advantage requirements… more
- CareFirst (Baltimore, MD)
- …claim overpayment scenarios. Performs analysis on claims, provider data, enrollment data, medical policies, claim payment policies for payment integrity ... written and oral communication skills. + Ability to review and understand CareFirst medical policies, claim payment policies and provider manuals. + Microsoft… more
- Excellus BlueCross BlueShield (Rochester, NY)
- …APR-DRG payment systems. This position is responsible for reviewing medical records for appropriate provider documentation to support the principal diagnosis, ... ICD 10CM, MS-DRG, and APR-DRG with a broad knowledge of medical claims billing/ payment systems, provider billing guidelines, medical necessity criteria, and… more
- Highmark Health (Little Rock, AR)
- …to accepted and established coding criteria, as well as other approved guidelines, payment and medical policies.Promote quality and efficiency in the delivery of ... claim review with the goal of proper and timely payment to provider and member satisfaction. The incumbent is...claims review basis. Review process includes a review of medical documentation, itemized bills, and claims data to assure… more
- LA Care Health Plan (Los Angeles, CA)
- …medical and reimbursement policies within the claim adjudication process through medical record review for Payment Integrity and Utilization Management ... Payment Integrity Nurse Coder RN III Job Category:...position serves as a subject matter expert (SME), performing medical records reviews to include quality audits as well… more
- Elevance Health (Seattle, WA)
- …abuse prevention and control. + Review and conducts analysis of claims and medical records prior to payment . Researches new healthcare-related questions as ... **Clinical Fraud Investigator II - Registered Nurse and CPC - Calrelon Payment Integrity SIU** **Location:** This role enables associates to work virtually… more
- HCA Healthcare (Ocala, FL)
- …accounts receivable follow-up, insurance follow-up and appeals, insurance posting, professional medical /billing, medical payment posting, and/or cash ... colleagues. The available plans and programs include: + Comprehensive medical coverage that covers many common services at no...both written and telephonically + Overcome objections that prevent payment of the claim and gain commitment for … more
- Minnesota Visiting Nurse Agency (Minneapolis, MN)
- …members, HCMC clinical areas, government agencies, employers, third party payors, and/or medical payment programs, etc. both in-person and by telephone to ... programs, etc.), determine financial responsibility, and/or to identify sources of payment for services * Requests, inputs, verifies, and modifies patient's… more
- UPMC (Pittsburgh, PA)
- …you'll be the key player ensuring accurate, timely, and compliant handling of medical records and documentation that supports payment processes. Your work helps ... everything running smoothly and efficiently. What You'll Do + Retrieve and organize medical records from multiple systems with precision. + Perform quality checks to… more
- Blue Cross Blue Shield of Massachusetts (Hingham, MA)
- …understanding of HMM's Utilization Management, Case Management and operational procedures, Medical and Payment policies, claims processing, insurance and ... ensure the most efficient use of resources, improve clinical outcomes, reduce medical expense, and meet stakeholder demands while supporting high-risk and high-cost… more
- Intermountain Health (San Juan, PR)
- …or workflow issues, and escalating in a timely manner + Advanced knowledge of Medical Terminology + Payment Handling + Effective written and verbal communication ... in a timely and accurate manner. **Essential Functions** + Identifies appropriate payment details and saves back-up as appropriate. + Researches, validates and makes… more
- HCA Healthcare (Brentwood, TN)
- …billing through clearinghouse, paper medical billing, insurance follow-up, and medical payment posting. + Prior experience reading and interpreting ... and retirement of our colleagues. The available plans and programs include: + Comprehensive medical coverage that covers many common services at no cost or for a low… more
- Mount Sinai Health System (New York, NY)
- …office schedule. 21. May participate in revenue cycle processes. 22. May perform medical scribe functions. 23. Payment posting and record keeping. 24. May ... **Job Description** The Senior Offsite Medical Secretary provides secretarial support to the supervising...during practice hours and may room patients. 14. Discuss payment arrangements with patients prior to office procedures/visits, in… more
- Centene Corporation (Cheyenne, WY)
- …involving complex, controversial, or unusual or new services in order to determine medical necessity and appropriate payment . + Develops alliances with the ... for our 28 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified, national organization offering… more
- Excellus BlueCross BlueShield (Buffalo, NY)
- …involving complex, controversial, or unusual or new services in order to determine medical necessity and appropriate payment . + Develops alliances with the ... we encourage you to apply! Job Description: This position assists the Chief Medical Director to direct and coordinate the medical management, quality improvement… more
- Motion Recruitment Partners (Denver, CO)
- …**What You Will Be Doing** Daily Responsibilities + Receives and adjudicates medical claims/bills for payment /denial. + Researches claims/bills for appropriate ... Medical Claims Processor / Contract / Remote Denver,...+ Analyzes and adjusts data and benefits criteria for payment . + Responds to and researches vendor and member… more
- Commonwealth Care Alliance (Boston, MA)
- …public health care programs and reimbursement methodologies (Medicaid and Medicare) + Medical Coding, Compliance, Payment Integrity and Analytics + Direct and ... direction of the Sr. Director, TPA Management and Claims Compliance, Healthcare Medical Claims Coding Sr. Analyst will be responsible for developing prospective… more
