of Job Ensure prompt, efficient, accurate and timely claims adjudication of high dollar claims in accordance with the current policy benefits, limitations or exclusions. Provide resolution of provider inquiries and collaborate with internal departments. Provide feedback or suggestions to enhance current processes and/or systems. Responsibilities Research and adjudicate hig

BASIC FUNCTION This position is responsible for constructing forecasts, recommendations and strategic/tactical plans based on business data and market knowledge. Creates specifications for reports and analysis based on business needs and required or available data elements. May provide consultation to users and lead cross functional teams to address business issues. Produ

Person Memorial Hospital Who We Are Our passion and purpose at Person Memorial Hospital are centered around people. We value individuals for who they are, not just for what they can do. Our fully accredited, 98 bed hospital has modern facilities and state of the art equipment to provide the highest quality healthcare. We offer four fully digital operating rooms, post anes

We have an exciting opportunity to join our team as a Assistant Director Reimbursement. In this role, the successful candidate is responsible for assisting in the overall planning, organization, direction, and control of the Reimbursement department. Interfaces with various hospital personnel regarding financial issues and analysis. The position will require the individua

Responsible for performing all physician, hospital and ancillary provider orientation, training and ongoing educational activities for CCHP network providers and their staffs. Responsible for the tracking of concerns, complaints and issues raised by network providers, and results reporting. Facilitates resolution of all complaints/issues raised by network providers relate

Under the direction of the Branch Manager or Field Leader, the Mobile Examiner's primary responsibility is to provide coverage in the field ensuring that mobile exams are completed accurately and on time. Maintain a safe and professional environment for applicants, clients, and employees, perform with confidence all aspects of an insurance exam, including specimen collect

Provide claims handling on complex/latent claims in compliance with claims handling procedures, client SLA and within agreed authority levels, including accurately capturing and updating claims data/information in compliance with best practices. Apply knowledge and judgement to determine liability by gathering and analyzing relevant facts; utilizing applicable law, determ

Under the direction of the Branch Manager or Field Leader, the Mobile Examiner's primary responsibility is to provide coverage in the field ensuring that mobile exams are completed accurately and on time. Maintain a safe and professional environment for applicants, clients, and employees, perform with confidence all aspects of an insurance exam, including specimen collect

Address and respond to back collectors' email group. Review and comprehend medical documentation efficiently. Manage back collectors' aging bucket and handle claim denials. Maintain effective communication with co workers and report concerns to the Collections Manager. Perform various clerical tasks such as answering phones, faxing, and emailing. Requirements Familiarity

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

Must have High school diploma, GED or equivalent required, Two year degree preferred. Minimum of 3 years previous experience working for a Health Plan, IPA, or other Managed Care Organization. Minimum of 2 years previous direct experience that included verifying and maintaining provider information and provider contract configuration in a managed care transaction system .

Vaco Boston has partnered with our client to help fill a Claim Adjuster role. Responsibilities Inspect property and physical damage Analyze complex information from different sources Examine claim liability Prepare and process claim reports Consult with specialists (e.g. physicians, engineers) Calculate benefits and payments Negotiate settlements with claimants Examine po

The Charge Data Specialist is responsible to complete the services of charges posted for areas of Children's National Health System. The Charge Data Specialist provides financial analysis, guidance, and advice to management consistent with standard charge posting practices. The Charge Data Specialist will ensure accurate and timely charge capture and quality assurance pro

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

This position supports the Risk Management Department in directing the worldwide Risk Management Property and Casualty insurance programs for asset protection and strategic advantage. Essential Duties and Responsibilities Manage process and performance to obtain optimal outcomes involving a claims portfolio of approximately 10 million of annual cash outflows, and other as