Investigate all non standard claim problems (25%) Investigates for COB and determine the primary payer (25%) Investigate and process adjustment requests (25%) Adjust claim payments resulting from duplicate payments, incorrect payee, etc. Recover expended funds for managed care plans System documentation of investigation results Training of Coordination of Benefits claim p

Assist in efforts to enhance ease of use of physician portal and future services enhancements Assist providers and members with basic inquiries about claims, authorizations, benefits, and other issues Fostering and maintaining proactive, positive relations throughout the provider network by communicating with provider offices through face to face visits, emails, telephone

Analyzes, configures, develops, tests, implements, supports and maintains Epic revenue cycle applications, solutions and business processes to meet operational and technical requirements. Obtains and maintains in depth knowledge of software functionality and acquires as well as utilizes knowledge of operational workflows to be implemented. Areas of responsibility may be H

Working under the direction of the Director, Business Applications & Analytics, this position is responsible for performing alpha and numerical data entry and data verification functions according to established procedures using Teleform, member research in IDX, and mailing of correspondence. The Claims Verifier will perform duties in accordance with guidelines set forth

3000 DaVita Way,Deland,Florida,32724 2039,United States of America Job Description GENERAL PURPOSE OF THE JOB The Specialist I, Denials (Lab) is responsible for the review and resolution of denied claims due to benefit issues, verifying applicable insurance coverage for multiple states, and determining correct coordination of benefits information. Applies the knowledge and

JOB DESCRIPTION Position Type Full time Type Of Hire Experienced (relevant combo of work and education) Travel Percentage 1 5% FIS is a leading provider of technology solutions for merchants, banks and capital markets firms globally. FIS stays ahead of how the world is evolving to power businesses in today's fast changing competitive landscape and help our clients run, gr

. Work Schedule and Additional Information Full time employment Work hours are 8 00 AM to 4 00 PM, Monday Friday, with 30 minute lunch. Telework You may have the opportunity to work from home (telework) part time. In order to telework, you must have a securely configured high speed internet connection and work from an approved location inside Pennsylvania. If you are unab

Universal Health Services (UHS), one of the nation's largest and most respected providers of hospital and healthcare services, one of the nation's largest and most respected providers of hospital and healthcare services, Universal Health Services, Inc. has built an impressive record of achievement and performance. In 2024, UHS was recognized By Newsweek and Plant A Insigh

At Children's Wisconsin, we believe kids deserve the best. Children's Wisconsin is a nationally recognized health system dedicated solely to the health and well being of children. We provide primary care, specialty care, urgent care, emergency care, community health services, foster and adoption services, child and family counseling, child advocacy services and family res

Overview Resolves grievances, appeals and external reviews for one of the following VNS Health Plans product lines Managed Long Term Care (MLTC), Medicare Advantage (MA), or Select Health. Ensures regulatory compliance, timeliness requirements and accuracy standards are met. Coordinates efficient functioning of day to day operations according to defined processes and proc

Directs the revenue cycle work load of co workers including auditing work for accuracy and completeness, re assigning work, and establishing priorities Reviews reports to verify that collection and billing submission tasks are completed and deadlines are met Provides procedure guidance and direction to co workers May research, resolve, or provide direction on co workers'

The SHOW comes alive at MGM Resorts International! Have you ever wondered what it would be like to work in a place full of excitement, diversity, and entertainment? Are you enthusiastic about being a team player in one of the most fascinating industries in the world? At MGM Resorts, we seek individuals like YOU to create unique and show stopping experiences for our guests

Welcome! We're excited you're considering an opportunity with us! To apply to this position and be considered, click the Apply button located above this message and complete the application in full. Below, you'll find other important information about this position. Responsible for managing patient account balances including accurate claim submission, compliance will all

Ensures functions performed in accordance with system wide policies, procedures, and governing organizations Defines individual and team goals Monitors staff and department performance and productivity levels and proposes ways to improve effectiveness, efficiency, and productivity Analyzes and identifies problem areas and adjust processes and staffing priorities Collabora

POPULATION SPECIFIC CARE No direct patient care. ESSENTIAL FUNCTIONS An employee in this position may be called upon to do any or all of the following essential functions. These examples do not include all of the functions which the employee may be expected to perform. Focuses on insurance accounts identified as high risk by the department. Notifies insurance company of s