The Senior Claims Specialist is responsible for the processing of complex institutional claims (stop loss, contracted, non contracted, per diem, case rate etc.) and adjudication and claims research when necessary. Senior Claims Specialist must have knowledge of compliance issues as they relate to claims processing and ability to identify and address non contracted provide

The Appeals Coordinator is responsible for the investigation and documentation of member appeals and grievances in compliance with State law, applicable rules and regulations and provider and group agreements. Works closely with the Plan's Medical Directors who are responsible for all decision regarding clinical appeals/ grievances and the Appeals Manager who is responsib

The Senior Claims Specialist is responsible for the processing of complex institutional claims (stop loss, contracted, non contracted, per diem, case rate etc.) and adjudication and claims research when necessary. Senior Claims Specialist must have knowledge of compliance issues as they relate to claims processing and ability to identify and address non contracted provide

Clinical Investigator starting approx. July 2023 UCSF Division of General Internal Medicine at San Francisco General Hospital The Department of Medicine at the University of California San Francisco (UCSF) is recruiting for a Clinical Investigator (MD/DO or PhD/DrPH/ScD trained) to join the faculty as an Assistant, Associate, or Full Professor in the Division of General I

Position Highlights Position Location 4201 Winfield Rd, Warrenville, IL Full Time 40 hours Hours Monday Friday 8 00AM to 4 30PM Required Travel No What you will do Prepares referrals/FMLA/disability forms per payer criteria for designated providers ensuring timely response to requests and meets established turnaround time. Prepares pre authorizations and FMLA/disability f

Responsible for review of the clinical information received from physicians, department queues and other clinical providers, ensuring clinical data is substantial enough to authorize services for both 1 time visit account types and recurring accounts. Analyzes clinical information to ensure the services requested are authorized according to clinical and payer protocols. R

Work From Home (WFH) This is a WFH position. The applicant must live within a one (1) hour radius of Dallas/Fort Worth and be available to come to the office for equipment pickup exchange, office meetings, and training, etc. Additional details in regard to WFH shall be discussed as part of the interview process. Shift 8 hour flex shift between 6am to 6pm Monday through Fr

Identifies and coordinates all aspects of financial obligations for private pay patients. Including, but not limited to, patient relations, physician liaison regarding financial liabilities, deposit estimates and collection. Assures that customer needs and/or complaints related to financial services are responded to and documented in a timely and professional manner and i

The Financial Coordinator is part of a team who handles the direct interaction with patients and their families during difficult times, providing financial insurance and payment information to assist them in planning and managing their account balances related to specific services performed in the clinic. The Financial Coordinator educates patients on the various sponsors

Financial Assistance Responsible for screening patients for MassHealth, CarePlus, Connector Care, Health Safety Net, assisting in the application process when appropriate. Submits applications all Massachusetts applications for health coverage via the Health Connector. The PBR will keep track of all cases using ONTRAC as well as a paper tickle file system. The PBR will al

Responsible for the analysis, research and completion of complex member appeal investigations. Effectively administer all steps of the member appeal and fair hearing processes for all non Medicare products to thoroughly investigate appeal requests, leveraging critical thinking skills, gathering relevant information from enterprise wide systems, and collaboration to resolv

This is a hybrid role; 3 days in office, 2 days remote The Claims Examiner investigates, and processes Workers' Compensation claims for VCUHS employees. This job assists in the coordination of an effective commercial insurance and self insured Workers' Compensation Claim Program that is compliant with state laws and that meets the needs of VCUHS. This job is responsible f

Financial Assistance Responsible for screening patients for MassHealth, CarePlus, Connector Care, Health Safety Net, assisting in the application process when appropriate. Submits applications all Massachusetts applications for health coverage via the Health Connector. The PBR will keep track of all cases using ONTRAC as well as a paper tickle file system. The PBR will al

Working under the direction of the Manager, Claims, this position has direct responsible for the supervision of staff and for overseeing the day to day operations of the Claims Processing and UM Denial Letter Units. Additional responsibilities include reporting functions to ensure compliance with AB1455, attention to CMS guidelines and department policy and procedures. Pr

Financial Assistance Responsible for screening patients for MassHealth, CarePlus, Connector Care, Health Safety Net, assisting in the application process when appropriate. Submits applications all Massachusetts applications for health coverage via the Health Connector. The PBR will keep track of all cases using ONTRAC as well as a paper tickle file system. The PBR will al