to create changes to allow our sales, claims, and product teams to operate accurately, quickly, and effectively. The ideal... new system request changes for UW, Sales & Claims Ensure the process follows company-assigned business rules Attend the...
Responsibilities The HIS Coding Denials Coordinator is responsible for evaluating and resolving denied claims... is needed for resolution. Reviews all denial accounts for categorization, level of appeal, special requirements for initiating appeals...
HIS Coding Denials Coordinator is responsible for evaluating and resolving denied claims within the Coding department under the... to determine if coding needs to be changed or if an appeal is needed for resolution. Reviews all denial accounts...
here. Summary Responsible for the resolution of disputes on escalated claims, utilization management, or other denials. Reviews...
concerning benefit and fee schedule interpretation NCCI (National Correct Coding Initiative) and other claims issues. Researches... incoming appeals and determines final resolution based on health plan policies and procedures. Uses knowledge of Medicaid rules...
, ensuring accurate issuant of car hire claims, and problem resolution of the fleet’s error default rates changes. Generate...
, ensuring accurate issuant of car hire claims, and problem resolution of the fleet’s error default rates changes. Generate...
related to eligibility/QLE, contributions, claims, overpayments, and general account maintenance. Complete custom processes... and/or participant issues for resolution. This position requires cross-functional teamwork skills as well as system and product knowledge...
. Excellent communication skills. Ability to document complex problems and assist in their resolution. Ability to understand... Service) Claims and Data Analytics Team (We support testing of work efforts/projects for all LOBs. Immediate Team – approx...
to document complex problems and assist in their resolution. Ability to understand functional connections between applications... Service) Claims and Data Analytics Team (We support testing of work efforts/projects for all LOBs. Immediate Team – approx...
required Knowledge, Skills, and Abilities Demonstrated understanding of benefits terminology, plan design, claims resolution...
approach to claims adjudication. As part of our Recovery and Resolutions team, you'll provide consultative support.... Primary Responsibilities: Define and document / communicate business requirements Analyze scope and resolution of medium...
approach to claims adjudication. As part of our Recovery and Resolutions team, you'll provide consultative support.... Primary Responsibilities: Define and document / communicate business requirements Analyze scope and resolution of medium...
to estimate future healthcare costs, revenue, and profitability. Analyzes claims data to assess patterns, trends, and cost... drivers and identifies opportunities for cost containment, fraud detection, and quality improvement in claims processing...
, manage, and resolve escalated and complex global issues for Claims/Calls, PSS, and health plan back-office operations. The... and complex global issues for Claims/Calls, PSS, and health plan back-office operations. The Plan Sponsor Liaisons serve...
at consignment locations by processing reports, reconciling inventory, problem resolution, repurchases, and possible product buybacks... levels weekly while assuring timely and accurate invoicing Audit invoicing and damage claims issues and take corrective...
all denied claims to understand the reason for denial or dispute. Work closely with Nurse Auditors to ensure they have all the.... Follow up and track the status of appeals and escalate as necessary to ensure timely resolution. ement compensation...
in the prompt, equitable resolution of claims. Provides consultative and resource support to staff regarding all aspects...: Collaborates with claims adjustors and defense counsel in managing claims including assessment of liability, ensuring establishment...
all denied claims to understand the reason for denial or dispute. Work closely with Nurse Auditors to ensure they have all the.... Follow up and track the status of appeals and escalate as necessary to ensure timely resolution. ement compensation...
from patient records. Collaborates with other risk staff in the prompt, equitable resolution of claims. Provides consultative... management throughout Aurora. Major Responsibilities: Collaborates with claims adjustors and defense counsel in managing...