Reviews clinical authorization denials and determines appropriate actions per payor to overturn the denial. Functions as a hospital liaison with external third party payors to review authorization denials. Job Duties Monitors and completes claims on team appeals, reconsiderations, and claim investigations. Works with the precertification department and other physician off

Reporting to the AVP, Enterprise Business Services PMO Program Director, the Testing Lead will be responsible for managing and overseeing all aspects of the ERP testing process from planning to execution, to validate the system's quality, reliability, and performance before deployment, minimizing potential issues and risks during implementation. The Testing Lead is respon

"The primary purpose of this role is to serve as a high risk claims analyst for the Legal department, handling litigated cases and sensitive brand issues. The role will also serve as an escalation point for the Claims Management department to transfer cases that, through development, meet specific triggers, also to consult on case value and jurisdictional nuisances. This

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

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

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

TMC Bonham Hospital is a 25 bed critical access hospital that includes both primary care and specialty physicians. The Critical Access Hospital, offering both inpatient and outpatient services along with 24 hour emergency services. The Critical Access Hospital (CAH) Program was established to assure access to healthcare services for rural residents. The program provides r

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 primary purpose of the Claims Support Specialist is to provide support and coordinate the administration of general liability claims in order to successfully resolve personal injury and property damage claims against the company and its subsidiaries in an efficient and appropriate manner ensuring operational excellence across assigned responsibilities. Key Responsibil

Requisition # 639074 Location Johns Hopkins Health System, Baltimore, MD 21201 Category Non Clinical Professional Schedule Day Shift Under general supervision, processes employee workers' compensation claims and benefits, including preparation of legal forms for the Workers Compensation Commission. Computes workers compensation benefits due employee as well as approving p

We are recruiting for a Director, Claims Denver Health Medical Plan to join our team! We are here for life's journey. Where is your life journey taking you? Being the heartbeat of Denver means our heart reflects something bigger than ourselves, something that connects us all Humanity in action, Triumph in hardship, Transformation in health. Department Managed Care Administ

Come work at a place where we take pride in creating a workplace environment that values hard work, commitment, and growth . Job Description Education High School diploma or equivalent required Associate's degree in Business Administration or relevant field of study preferred Insurance adjuster license required Work Experiences 4+ years' claims experience working with wor

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

Under general supervision of the Follow up Supervisor performs all duties necessary to follow up on outstanding claims and correct all denied claims for a large physician specialty practice. Responsibilities Review all denied claims correct them in the system and send corrected/appealed claims as written correspondence fax or via electronic submission. Identify and analyz

Maintains, confirms and secures referrals, authorization, or pre certifications required for patients to receive physician or medical services. Verifies the accuracy and completeness of patient account information. Maintains database of payer authorization requirements. Ensures information obtained is complete and accurate, applying acquired knowledge of Medicare, Medicai