; independently coordinates the resolution with internal/external parties as required; and documents and summarizes to all parties... resolution results and relay investigative results with all involved parties. Participate in workgroup meetings to address...
(i.e., patient access, patient accounting, claims clearinghouse, eligibility, etc.). Tasks are performed under the direction of lead... and good organizational, time management, interpersonal, and conflict resolution skills, excellent decision making skills...
(PBM) benefit administration, this position will drive identification and resolution of issues by partnering... Pharmacy Benefit Management (PBM) benefit administration, this position will drive identification and resolution of issues...
will be aligned with your schedule. Primary Responsibilities: Process files and manage claims through the complete invoicing... resolution. Responsible for driving claim resolution payors assigned to team Assist with mentoring and training Other duties...
and collections to include double recoupment, correspondence and credit balance resolution. Job Description: Education... tasks and manage time efficiently to meet deadlines, Knowledge of computer based claims management, Knowledge of database...
, contract language, service, claims or compensation issues, and provider education needs. Optimizes interactions with assigned... but not limited to, claims payment, contract interpretation or parameters, and accuracy of provider contract or demographic...
, master data/account maintenance, and resolution of inquiries via Help Desk tickets, while ensuring quality, compliance... inquiries received via ProShop Help Desk for claims, imprint, account maintenance, and other order questions. Maintain ticket...
to interface problem identification, triage and resolution of complex inquiries. Discuss users' needs and determine vulnerabilities.... Procure additional technical assistance to help in problem resolution. Process Improvements Work as a team member or lead...
will have a strong knowledge of insurance including Claims and Underwriting concepts including the concepts of loss development. Understands the... to drive to problem resolution. Possess a thorough understanding of IS project management principles. Ability to collaborate...
. Coordinates insurance claims process and works with senior management for resolution of claims. Conducts annual insurance self...
by providing support to the Bank’s Fraud/Security Manager through identification, research, tracking, reporting, and resolution... or denying claims and/or possible account closure. Assist in the review and decisioning of the various alert solutions to ensure...
, and resolution progress to stakeholders. Identify recurring issues and recommend improvements. Support testing, validation...% annually. Preferred Qualifications Experience with Trade Promotion Management processes (promotions, accruals, claims...
and maintain AI agents for claims automation, underwriting support, risk assessment, and compliance use cases within P&C insurance... best practices, software design patterns, and insurance domain context. Collaborate cross-functionally with underwriting, claims...
-billing, collection and follow up procedures to effectively expedite prompt resolution of denied claims. Uses proper... involving the analysis of accounts denied by insurance carriers. Identifies issues resulting in the denial of claims. Takes...
to promote on-going enhancements to program installation. Mediates and coordinates resolution of all project deliverables... Qualifications 7 years of in depth knowledge of healthcare, PBM, Account Management Medicare experience Knowledge of Claims...
prompt resolution of denied claims. Uses proper escalation procedures both internally and externally after exhausting... resulting in the denial of claims. Takes corrective action to facilitate the re-billing and/or appeal of claims and the...
revenue data specific to Pricing, Claims Reimbursement and Integrity of Payer Contract Management for Yale Medicine... with payment issues until resolution when identifying and escalating payment trends. Through detailed data mining and analysis...
to resolution and participating in routine meetings with multiple areas of the organization as well as external entities.... · Partners with IS and RCO departments to ensure claims are going out with the correct modifiers and claim data. · Proactively...
quality and cost of health care. Extract data from electronic medical records, claims, HMSA Data Warehouse... activities. Develop project plans for implementation to lead and coordinate problem tracking, resolution and verification...
Summary Resolve and document fraud and deposit regulatory claims. Work with local authorities regarding fraud... and correspond with attorneys for resolution. Receive and make decisions on Federal reclamations of funds. Audit deposit exceptions...