- 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
- Otsuka America Pharmaceutical Inc. (Honolulu, HI)
- **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
- Walgreens (Honolulu, HI)
- …submission of claims to government- sponsored health care programs, including Medicare , Medicaid, and all other third-party payers, as well as the facilitating ... and growing the business at the site. Performs all duties of the Pharmacy Manager in their absence. + Models and shares customer service best practices with all… more
- Datavant (Honolulu, HI)
- …to realize our bold vision for healthcare. **Role Overview** As a Product Manager , Risk Adjustment Analytics Products, you will contribute to the strategy and ... outcomes, measure product impact, and support value-based client delivery across Medicare Advantage, ACA, and Medicaid programs. The ideal candidate combines deep… more
- Cardinal Health (Honolulu, HI)
- …equivalent preferred + Patient Support Service experience, preferred + Clear knowledge of Medicare (A, B, C, D), Medicaid & Commercial payers policies and guidelines ... pharmacy insurance benefit practices, preferred + 1-2 years of Pharmacy and/or Medical Claims billing and Coding work experience + 1-2 years experience with Prior… more
- Humana (Honolulu, HI)
- …closely with IT, the pricing software vendor, CIS BSS, Medicaid operations, claims operations, and other business teams involved in the administration of Medicaid ... APR-DRG and/or EAPG grouper logic + Experience processing or reviewing facility claims + Prior professional experience utilizing Microsoft Excel (eg performing basic… more
- Queen's Health System (Honolulu, HI)
- …Works with designated staff to ensure accurate and timely processing of claims , overturning denials, appeals and credits. * Ensures functions and activities are ... and established goals, objectives, and organizational initiatives. * Assists the Manager with activities to support the mission, vision, and strategic goals… more
- Highmark Health (Honolulu, HI)
- …system entities in response to external coding audits conducted by the Medicare Administrative Contractor, the RAC, MIC, ZPIC, etc. Determine appeal action, prepare ... related to special projects and providing coverage for coding manager (s). (10%) + Depending on location provides or arranges...skills Preferred + Associate's Degree + 3 years with claims processing and data management + Past auditing and… more