- CVS Health (Albany, NY)
- …solutions to make health care more personal, convenient and affordable. Position Summary laim Audit Quality Analysts need to have a wide depth and breadth of ... of detail and review.A candidate must become subject matter experts in claims , plan documents, eligibility, coverages, and quirks of multiple groups. Knowledge in… more
- CVS Health (St. Paul, MN)
- …systems and on daily operations and programs * Responsible to support targeted quality audit projects. Report results and make recommendations eg, training ... quality champion through measuring and monitoring the quality and effectiveness of work processes in claim...test plans and strategies * Analyze and resolve complex claims scenarios within established time frames * Resolves problems… more
- LogixHealth (Bedford, MA)
- Location: On-Site in Bedford, MA This Role: As a Claims Specialist , you will work with internal teams to provide cutting-edge solutions that will directly ... and carry out processes on all out of network claims . The ideal candidate will have strong technological skills,...clinical, and other data insights that directly improve the quality and efficiency of patient care. At LogixHealth, we're… more
- Axis (Princeton, NJ)
- …upon request for candidates taking part in the selection process. AXIS is seeking a ** Claims Specialist ** to join our North America Claims team reporting to ... of Casualty Claims . This position requires senior claims management and handling expertise for both the oversight...Assurance - Comply with best practices measured by monthly Quality Assurance and Management Initiated Audit scores… more
- Blue Cross and Blue Shield of Louisiana (Baton Rouge, LA)
- …CLAIMS OPERATIONS Necessary Contacts: In order to effectively fulfill this position, the Claims Specialist I must be in contact with personnel in other Units: ... Duties may include the following responsibilities or functions required to support the claims unit. Accurate processing of claims edits, determining primacy for… more
- Providence (Anaheim, CA)
- **Description** Manage the claims internal audit functions, which includes audit process for adjudicated claims and encounters. Monitor check run process ... for accuracy. Develop policies and procedures for periodic claims audits and ensure compliance with affiliated health plans, client groups, and administrative… more
- BrightSpring Health Services (Louisville, KY)
- Our Company BrightSpring Health Services Overview The Clinical Coding and Audit Specialist monitors, responds and performs the clinical coding and audit ... with Home Health operations and customers to drive improvement in the quality of services delivered to patients. Responsibilities + Code diagnosis accurately… more
- Subaru of America (Camden, NJ)
- …and career development. Conducts quality checks through phone observations and claim reviews. Works together with Retailer Claims management on department ... the quality of work of the Retailer Claims Specialists through phone observations and claim ...correcting business rules. + Manages workflow, attendance, lunch, and audit schedules for Retailer Claim Specialists. SKILLS… more
- Dignity Health (Sacramento, CA)
- …Works closely with the finance accounting & coding departments to ensure claims are populated with correct/proper coding based on Medicare and Medi-Cal billing ... to detail to minimize coding errors, performs compliance and quality audits, and ensures accurate billing *Print and use...team. Notify provider in person or via phone. *Prepare audit reports via Cerner Discern; audits in a timely… more
- State of Colorado (Denver, CO)
- Community Living Data & Claims Analyst Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/4533291) Apply Community Living Data & Claims ... for overtime compensation. Department Contact Information Jessica Bosick, Talent Acquisition Specialist ~ ###@state.co.us How To Apply Please submit an online… more
- Beth Israel Lahey Health (Burlington, MA)
- …and accurately appeal claims to ensure successful initial submission. The Billing Specialist will be responsible for charge and claim review to ensure the ... **Work Shift:** Day (United States of America) The Billing Specialist role specializes in high dollar claims ,...claim and it was billed appropriately. The Billing Specialist will work directly with Supervisors and Managers to… more
- UT Health (Houston, TX)
- Coding Quality Specialist (Remote) **Location:** Houston, Texas **Hot** **Category:** Professional/Managerial McGovern Medical School at UTHealth Houston ... UTHealth Houston Revenue Cycle is hiring for a **Coding Quality Specialist ** to join their team of... reviews** on the coding staff, reviewing the random audit work queue, **correcting claim edits** ,… more
- Beth Israel Lahey Health (Burlington, MA)
- …and maintains open communication with third party payor representatives in order to resolve claims issues. 4. Reviews claim forms for the accuracy of procedures, ... provider documentation in order to determine appropriate coding and initiate corrected claims and appeals. Duties include hands on coding, documentation review and… more
- Medical Mutual of Ohio (OH)
- …to software quality assurance and testing. . Strong knowledge of claims adjudication systems and processes. . Strong analytical and problem-solving skills with ... of training and experience. . 2 years' experience as a Business Systems Specialist or equivalent experience with software quality assurance and testing. .… more
- Beth Israel Lahey Health (Burlington, MA)
- …and maintains open communication with third party payor representatives in order to resolve claims issues. 5. Reviews claim forms for the accuracy of procedures, ... and interprets third party payments, adjustments and denials. Initiates corrected claims , appeals and analyzes unresolved third party and self-pay accounts,… more
- Beth Israel Lahey Health (Charlestown, MA)
- …and maintains open communication with third party payor representatives in order to resolve claims issues. 5) Reviews claim forms for the accuracy of procedures, ... and interprets third party payments, adjustments and denials. Initiates corrected claims , appeals and analyzes unresolved third party and self-pay accounts,… more
- Medical Mutual of Ohio (Brooklyn, OH)
- …training and experience.** + **2 years of experience as a Business Systems Specialist or equivalent experience with software quality assurance and testing.** ... and experience.** + **5 years progressive experience as a Business Systems Specialist or equivalent experience with software quality assurance and testing… more
- HCA Healthcare (Brentwood, TN)
- …**Introduction** Do you have the career opportunities as a Denial Coding Review Specialist you want with your current employer? We have an exciting opportunity for ... you want to work as a(an) Denial Coding Review Specialist where your passion for creating positive patient interactions...researching, analyzing, and resolving outstanding clinical denials and insurance claims . What you will do in this role: +… more
- Ketchikan Indian Community (Ketchikan, AK)
- General Information Job Title: Quality Improvement Specialist Date Posted: 05/31/2024 Location: Health Administration Office Compensation and Hours Minimum ... to alter this job description at any time without notice. Job Summary The Quality Improvement Specialist representative will assist the Quality Director in… more
- Burrell Behavioral Health (Kirksville, MO)
- …financial records? Join our team at Preferred Family Healthcare as a Billing Specialist ! In this role, you'll oversee the in-house database, ensure accuracy of ... various departments to streamline billing processes. As a Billing Specialist , you'll be responsible for maintaining accurate billing records,...Kirksville is a community driven hub with a high quality of life. Join us in making a difference… more