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Responsible for auditing and training claims staff on all Managed Care claims received from outside providers to ensure the Claims Examiners processed and adjudicated them accurately and consistently in accordance with outside Provider Contracts, State, Federal, CMS, DMHC and Health Plan contracts, internal departmental policies and procedures. Must maintain a productivit

The Claims Supervisor will play a crucial role in ensuring the efficient and accurate processing of healthcare claims within our organization. You will lead a team of claims analysts, oversee claim submission, review, and adjudication processes, and collaborate with various stakeholders to maintain high quality claims management practices. This role demands strong leaders

Provider Relations Representative is responsible for assisting in the full range of provider relations and service interactions for all lines of business within Prominence Health Plan. Will assist in the design and implementation of programs to build and nurture positive relationships between the health plan, providers (physician, hospital, ancillary, etc.), and practice

Insurance Coordinator is responsible for proactive management of the insurance authorization process. Supports clinicians by managing insurance authorizations/certifications (initial/ongoing) process. Assists patients with the financial and authorization issues related to their care. Supports all ambulatory PT/OT practice sites. Proactively, effectively and efficiently ma

Position will be responsible for answering of Health Plan phone lines and response to Provider inquiries relating to claims, benefits, and Health Plan policies. The position is also responsible for developing and maintaining working relationships with CCHP Providers. The position is responsible for meeting department production and quality goals. Dependable attendance is

Medical Administrators on the Heartbeat program work at client sites in the Northern Virginia region, providing a variety of office support and customer service duties within a medical office setting. Responsibilities will vary based upon the medical office's day to day needs and may include; Providing front desk/reception support Answering phones and routing calls Facili

The Senior Patient Financial Counselor is responsible for insurance and eligibility verifications and assessment of financial requirements of recommended treatments including, but not limited to, chemotherapy, radiation therapy, office visits, integrated supportive care services, and other cancer related therapy or services. The Senior Patient Financial Counselor counsels

Claim Specialist II ID 2024 23167 Location Professional Fee Billing Work Location US NC Greensboro Division Name System Wide Department Name SW Pro Fee Billing Category CLERICAL/ADMIN Position Sub Category INSURANCE/BILLING Position Type Full Time (40 hours/week) Employment Type Employee Exempt/NonExempt Non Exempt FTE 1.00 Workforce Status Hybrid I Work Hours 40.00 Provi

Claims Representative THERAPY, Providence Mount Carmel Hospital Colville, WA Under the supervision of the Rehab Services Manager or Assistant Manager, the Insurance Coordinator provides support to the department and its patients concerning insurance coordination and authorization. Demonstrates behavior practices that reflect the philosophy and mission of our sponsors, Pro

The Insurance Follow Up Specialist contributes to the financial viability of the organization by assuring that accounts have been properly billed and reimbursed. Responsibilities include contacting the appropriate insurance company to secure and expedite payments through the follow up and appeals resolution processes, and acting as a functional leader or reference source.

Job Duties The duties of this position include filing dental insurance claims and pre treatment estimates for privately insured patients; obtaining and providing the clinical documentation necessary for claims processing, i.e. x rays, chart notes and letters of necessity; investigating certain denied claims, following up on those investigations and submitting claims appea

Gundersen Health System is looking for an experienced individual to help our Professional Coding and Reimbursement Team continue to succeed and advance! The Supervisor works under the direction of the Director to effectively accomplish the duties and responsibilities outlined in Gundersen Health System’s Supervisor Job Charter. Supervises the daily operations of the

Serve as single point of contact to the physician network and is an accountable owner, responsive to physician needs. Knowledgeable about incentive programs, contract reimbursement, Optum's internal processes and priorities, and other Optum initiatives, as applicable Monitors performance of assigned PCPs, identifies low performing PCPs and works with IPA leadership to dev

3000 DaVita Way,Deland,Florida,32724 2039,United States of America GENERAL PURPOSE OF THE JOB The Specialist I, Collections (Lab) is to secure maximum reimbursement on all claims based on payer terms. Applies the knowledge and skills to complete a wide range of tasks at a level which meets department standards and ensures goals and objectives are achieved. Ensures claim ad