- Sedgwick (Toledo, OH)
- …as a Great Place to Work(R) Fortune Best Workplaces in Financial Services & Insurance Director Complex Claims **PRIMARY PURPOSE** **:** To be responsible for ... managing SIU investigations of complex fraud schemes involving providers, vendors, attorneys and others;...degree from an accredited college or university preferred. Fraud Claims Law Associate (FCLA), Certified Insurance Fraud Investigator (CIFI),… more
- Sedgwick (Toledo, OH)
- …and documents contacts, interviews and information in appropriate system(s); staffs complex case management claims ; provides direction for clinical decisions; ... membership in professional organizations and continuing education. + Works with Medical Director to identify clinical training needs and coordinates with trainer (s)… more
- Molina Healthcare (Toledo, OH)
- …contracting negotiations and understanding of alternative arrangements. Maintains critical Complex provider information on claims and provider databases. ... federal, state and local regulations. Responsible for contracting/re-contracting of Complex contracts with Alternative Payment Methods including but not limited… more
- ProMedica Health System (Toledo, OH)
- REPORTING RELATIONSHIPS/SUPERVISORY RESPONSIBILITIES This position reports to the Director , Professional Coding, Audit & Education has no direct reports. POSITION ... regulatory changes or updates. Reviews medical record documentation and claims data to ensure compliance with CMS and payer...Years of Experience: Minimum of 3 years of physician/professional complex surgical and E&M coding experience in a health… more