S.; may work from home] to maintain and support the multi-tenant core adjudication engine of the PharmacyBenefit Management Platform for different states covering their Medicare and Medicaid Plan. To ...
Conduct audits on program builds across adjudication platforms * Accurately maintain the program database updated and current based on business needs * Assist with aggregating data for Patient Access ...
Coordinates and clarifies with providers, when necessary, on information that seems incomplete or is lacking for proper account/ claim adjudication * Responsible for correcting, completing, and ...
In-depth knowledge of healthcare revenue cycle processes, claim adjudication, and reimbursement methodologies. * Familiarity with insurance denials, appeals, and arbitration processes, including ...
Provide outstanding customer service and technical expertise, working efficiently with the insured, brokers and underwriters in the handling and adjudication of claims. * Analyze and draft coverage ...