- Seattle Children's (Seattle, WA)
- …audits by third parties conducted to reduce payment for reasons other than the medical necessity of care. The Audit Management Specialist will coordinate with ... The Audit Management Specialist will complete and communicate the status of...Information** Seattle Children's offers a generous benefit package, including medical , dental, and vision plans, 403(b), life insurance, paid… more
- Seattle Children's (Seattle, WA)
- …or hospital billing or accounts receivable follow-up experience. Experience working with medical claims and electronic data interchange systems, eg Epic, Relay ... Completion of the Seattle Children's Revenue Cycle Coordinator program or accredited medical billing/coding program. Minimum of two years of experience in Windows… more
- University of Washington (Seattle, WA)
- …Medicine Faculty Practice Plane Services has and outstanding opportunity for a ** Claims Specialist (Patient Account Representative 2).** This position is ... responsible for claims review, clearing claim edits, and timely and accurate...information, posting rejections, or forwarding the claim to a medical coding specialist for review and coding… more
- Philadelphia Insurance Companies (Seattle, WA)
- …of Ward's Top 50 and rated A++ by AM Best. We are looking for a Claims Specialist to join our team! Summary: Investigate, evaluate and settle more complex first ... and third party commercial auto insurance claims . A typical day will include the following: Thoroughly understands coverages, policy terms and conditions for broad… more
- Molina Healthcare (Bellevue, WA)
- …combination of education and experience **PREFERRED EXPERIENCE:** 3+ years healthcare Medical claims auditing **PHYSICAL DEMANDS:** Working environment is ... clear and concise to ensure accuracy in auditing of critical information on claims ensuring adherence to business and system requirements of customers as it pertains… more
- Molina Healthcare (Bellevue, WA)
- Molina Healthcare is hiring for a Medicare Appeals & Grievances Specialist . This position is remote and will be working Pacific Standard hours. Highly Qualified ... to detail + AOR/IRE understanding highly preferred Provides support for claims activities including reviewing and resolving member and provider complaints, and… more
- Terumo Medical Corporation (Seattle, WA)
- …the Cath Lab or Interventional Radiology environment. Prior experience as a Field Clinical Specialist with a medical device company is preferred. It is Terumo's ... Field Clinical Specialist , Seattle North Date: Nov 4, 2025 Req...Req ID: 5306 Location: Seattle, WA, US Company: Terumo Medical Corporation Department: TIS Sales - Big Sky Terumo… more
- University of Washington (Seattle, WA)
- …Plan Services (FPPS)** has an outstanding opportunity for an **Insurance Follow-Up Specialist ** to join our **Medicare** team **.** **WORK SCHEDULE** + 100% FTE ... + Mondays - Fridays + 100% Remote **POSITION HIGHLIGHTS** The **Insurance Follow-Up Specialist , Medicare** is responsible for the optimal payment of claims from… more
- Molina Healthcare (Bellevue, WA)
- JOB DESCRIPTION Provides support for claims activities including reviewing and resolving **Provider No Surprises Act** cases in accordance with the standards and ... ensure that internal and/or regulatory timelines are measured correctly. * Researches claims using support systems to determine **Provider No Surprise Act** cases… more
- Molina Healthcare (Bellevue, WA)
- …to ensure that internal and/or regulatory timelines are met. + Research claims appeals and grievances using support systems to determine appeal and grievance ... outcomes. + Requests and reviews medical records, notes, and/or detailed bills as appropriate; formulates conclusions per protocol and other business partners to… more
- CDM Smith (Bellevue, WA)
- …40509BR **Business Unit:** FSU **Job Description:** The Disaster Program Delivery Specialist : * Collects, coordinates and/or reviews applicant data to determine ... expertise may be needed throughout the program delivery process. * Supports the claims process by reviewing and validating damage details, scopes of work, and costs… more
- PDS Defense (Seattle, WA)
- **Light Industrial/Manufacturing** **Supply Chain Specialist 1** Seattle, WA Posted: 11/5/2025 Job Description Job ID#: 213436 Job Category: Light ... W2 Duration: 52 Shift: 1 **PDS Defense, Inc. is seeking a Supply Chain Specialist 1, in Seattle, WA. Job ID#213436** **Pay Rate: $31 - $36/hr** **Job Description:**… more
- Molina Healthcare (Bellevue, WA)
- …and timely validation and maintenance of critical provider information on all claims and provider databases. Staff ensure adherence to business and system ... care experience + Experience in one or more of the following: Claims , Provider Services, Provider Network Operations, Hospital or Physician Billing, or similar.… more
- Molina Healthcare (Bellevue, WA)
- …to state and federal and Molina Healthcare guidelines. + Requests and obtains medical records, notes, and/or detailed bills as appropriate to assist with research. + ... and grievances. + Elevates appropriate appeals to the Appeals Specialist . + Generates and mails denial letters. + Assists...**C** **E:** + 1 year of Molina experience, health claims experience, OR one year of customer service/provider service… more
- Insight Global (Tukwila, WA)
- …License * 2 years' Experience in health care or pharmacy billing, collections, or medical claims processing * 2 years' Experience as a pharmacy technician in ... Job Description * The Pharmacy Billing Specialist is responsible to proactively audit, monitor, and analyze complex dispensing and charging information, including… more
- Molina Healthcare (Bellevue, WA)
- …and FQHC/RHC reports. + Generates other provider-related reports, such as: claims report extractions; regularly scheduled reports related to Network Management (ER, ... Experience** + 3-5 years managed care experience, including 2+ years in Provider Claims and/or Provider Network Administration. + 3+ years' experience in Medical … more
- Molina Healthcare (Bellevue, WA)
- …care. **ESSENTIAL JOB DUTIES:** + Facilitates clinical/ medical reviews of retrospective medical claim reviews, medical claims and previously denied cases ... to be made, to ensure medical necessity and appropriate/accurate billing and claims processing. + Reevaluates medical claims and associated records by… more
- Molina Healthcare (Bellevue, WA)
- …diagnosis-related group (DRG) validation tools and process improvements - ensuring that member medical claims are settled in a timely fashion and in accordance ... auditing, quality assurance, recovery auditing, DRG/clinical validation, utilization review and/or medical claims review, or equivalent combination of relevant… more
- Elevance Health (Seattle, WA)
- …unless an accommodation is granted as required by law._ The **Excess Loss Specialist ** is responsible for working independently reviewing claims and interpreting ... **Excess Loss Specialist ** **Location :** This role enables associates to...+ Assists auditors with obtaining information for stop loss claims . + Tracks payments from third-party administrators that have… more
- Molina Healthcare (Bellevue, WA)
- …to law enforcement or for payment recovery. **KNOWLEDGE/SKILLS/ABILITIES** + Reviews post pay claims with corresponding medical records to determine accuracy of ... to present those findings. **Preferred License, Certification, Association** + AAPC Certified Medical CPC, CPMA, CPCO or similar specialist preferred + Certified… more
