- CareFirst (Fairfax, VA)
- …leadership. **Knowledge, Skills and Abilities (KSAs)** + Knowledge of call center operations claims and/or enrollment and billing and workflows. + Strong ... support, client services, client administration, customer service, enrollment and eligibility, claims processing, and call center operations . Investigates and… more
- TEKsystems (Honolulu, HI)
- Medicare Claims Manager Must... 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... operations across all lines of business, including Medicare , Medicaid, and commercial insurance. Key Responsibilities: Claims… more
- Chesapeake Regional Healthcare (Chesapeake, VA)
- …(Palmetto GBA) and CMS web sites + Understanding of the CMS Publication: 100-4 ( Medicare Claims Processing Manual) + Ensures claim information is complete and ... limited as other tasks may be assigned. + Submit Medicare / Medicare Advantage plan claims both...deemed necessary by management , to ensure efficient department operations + Report potential or identified problems with systems… more
- System One (Dayton, OH)
- …opportunity working 100% remote. This person must have a strong domain expertise in Claims and Facets experience. The Project Manager II is responsible for ... all levels + Escalate issues to Business Owner, Program Manager , and IMO Leadership as applicable + Drive cross-functional...+ Maintain RAID for project items + Develop project operations and support plan + Perform any other job… more
- LA Care Health Plan (Los Angeles, CA)
- …Preferred Provider Groups (PPG), Specialty Health Plans (SHP) and Pharmacy Benefit Manager (PBM) including LA Care's Claims Department. This requires interaction ... Specialty Health Plans Claims Auditor III Job Category: Accounting/Finance Department: Financial...of LA Care deficient delegates. Participates in Centers for Medicare and Medicaid Services (CMS) claim audit section of… more
- Central Ohio Transit Authority (Columbus, OH)
- …under ORC 2744; + Reviews all event reports for accuracy; creates claims , and maintains documentation in applicable systems (Origami); + Conducts investigation of ... interviews with witnesses and principals involved; + Works with Transit Operations personnel by taking pictures of physical evidence and taking measurements… more
- Waystar (Lehi, UT)
- …closely with User Experience team and Technology teams. The Sr. Product Manager will coordinate with key stakeholders in sales, marketing, design, development, and ... operations . This role will be charged with leading game...systems, and is connected to over 5K commercial and Medicaid/ Medicare payers. We are deeply committed to living out… more
- Guidehouse (San Marcos, CA)
- …billing systems and billing processes. The Billing Supervisor reports directly to an Operations Manager or Director level position and may perform any and ... You Will Do** **:** The **Billing Supervisor - Healthcare Claims ** is responsible for the daily operations ...CPT, HCPCS and Revenue Codes. + Provide departments with Medicare and other payer updates, notices and coverage changes… more
- CareOregon (Portland, OR)
- …Utah, Idaho, Arizona, Nevada, Texas, Montana, or Wisconsin. Job Title Clinical Operations Manager Department Clinical Operations Exemption Status Exempt ... Requisition # 24958 Direct Reports Team Supervisors and Support Staff Manager Title Director, Clinical Operations Pay & Benefits Estimated hiring range $ 135,420… more
- The County of Los Angeles (Los Angeles, CA)
- MANAGER II, FACILITIES OPERATIONS AND CRAFTS, ENVIRONMENTAL SERVICES Print (https://www.governmentjobs.com/careers/lacounty/jobs/newprint/4762503) Apply ... MANAGER II, FACILITIES OPERATIONS AND CRAFTS, ENVIRONMENTAL...quality and safety standards consistent with the Centers for Medicare and Medicaid Services requirements. Assisting in the management… more
- Caris Life Sciences (Irving, TX)
- **Position Summary** Caris is seeking a full time Manager for our Billing Operations to oversee the day-to-day operations for a defined payor group. This ... receivable management by monitoring and following up on unpaid claims , denied claims , and billing discrepancies. +...of privacy of patient data. + Experience working with Medicare Advantage plans is a plus + Experience with… more
- Amazon (New York, NY)
- Description Amazon One Medical is hiring a Actuarial Manager Analyst. Actuarial rigor is one of the keys to our success. This candidate will responsible primarily ... for several critical workstreams which include analysis of Medicare Advantage and Accountable Care Organization data, design and implement an actuarially sound… more
- Elevance Health (Norfolk, VA)
- …Experience processing claims with CI&W (WGS) preferred. + Healthcare commercial claims operations experience preferred. + JAA experience preferred. Please be ... **Financial Operations Recovery Specialist II** **Location:** Virtual/remote opportunity. The...responsible for the discovery, validation, recovery, and adjustments of claims overpayments. May do all or some of the… more
- BrightSpring Health Services (Englewood, CO)
- …collection of all Accounts Receivable, including but not limited to, Government, Medicare , Medicaid, and commercial insurances. The Collections Manager will ... through our growing network of branches and healthcare professionals. The Collections Manager will be capable of performing and supervising all activities related to… more
- BrightSpring Health Services (Louisville, KY)
- …to support the Medicare Advantage Institutional Special Needs Plan (I-SNP), the Manager will work in collaboration with all clinical and operations staff on ... Medical Services company, Population Health Management services company, and a Medicare Advantage Institutional Special Needs Plan (I-SNP).Under the direction of the… more
- Walgreens (Decatur, GA)
- …policies inclusive of participating in the billing and submission of claims to government-sponsored health care programs, including Medicare , Medicaid, ... payers, as well as the facilitating of prior authorizations on behalf of prescribers. ** Operations ** + Works with the Pharmacy Manager toward the success of the… more
- VNS Health (Manhattan, NY)
- …is seeking a dedicated Manager , Grievance and Appeals (RN)to lead the daily operations of our grievance and appeals processes. You will play a crucial role in ... and appeals across our Managed Long Term Care (MLTC), Medicare Advantage (MA), or Select Health product lines. *...Claims , Medical Director, third party administrator, pharmacy benefit manager , to achieve resolution of appeals and grievances. +… more
- Fallon Health (Webster, MA)
- …to be the leading provider of government-sponsored health insurance programs-including Medicare , Medicaid, and PACE- in the region. **Brief summary of purpose:** ... care encounters in the EMR to facilitate submission of claims and diagnostic data to FH systems. * Delegates...setting as needed. * Collaborates with the Home Care Manager to assure that home safety evaluations are complete… more
- Houston Methodist (Houston, TX)
- …clinical trial protocols, study budgets, coverage analyses, etc. - Performs detailed claims testing and medical review. - Reviews Medicare Coverage Analysis ... At Houston Methodist, the Manager of Research Billing Compliance position is responsible...work environment. This position also implements training, monitoring and operations initiatives that secure compliance with ethical and legal… more
- State of Massachusetts (Boston, MA)
- …force in health policy impact! We are seeking a Data Strategy and Client Insights Manager to join our Data Operations & Technology team. Reporting to the Chief ... *To apply visit: Data Strategy and Client Insights Manager *Please do not apply through MassCareers. *...data sets, including ICD-9/ICD-10 coded data and health care claims (eg, APCD, Medicare Fee-for-Service, MarketScan Market… more