Searchable words: Billing, Paralegal, Plan Claim adjudicator, Claims Processor, Collections, Patient Accounting, Patient Financial Services Representative, Patient Accounts Representative, Insurance Collector, Insurance Collector Specialist, Business Office Representative, Biller, Workers Compens...
SUMMARY Manages, supervises and coordinates activities of the Claims Department to provide reasonable claims adjudication in compliance with all laws, regulations and contractual commitments
Ensures approval of claims by performing appropriate edits and/or reversals to ensure maximum payer reimbursement * Monitors and resolves at risk revenue associated with payer set up, billing ...
Research and document pertinent information on claims requiring adjudication. Apply medical policy, contractual provisions, and operational procedures to ensure accurate adjudication and/or ...
High School diploma (or GED or High School Equivalence Certificate) required Bachelor's degree preferred; minimum of 3 years related medical claims adjudication experience required. * Knowledge of ...
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Resolve claims adjudication issues. Responsible for hiring, training, coaching, counseling, and evaluating team member performance. Demonstrate effective leadership by coaching to improve individual ...
Ability to use automated claims adjudication software. * Good verbal and written communication skills as well as strong interpersonal skills. * Good analytical and organizational skills, as well as ...
Ascendant Claims Services LLC, (an affiliate of Ascendant Commercial Insurance Inc.) is a third-party claims administrator committed to providing best in class claims adjudication solutions
Assess auto adjudication outcomes and review carve-outs in the Division of Financial Responsibility (DOFR). * Process reports and collaborate with management and claims unit as necessary. * Support ...
Moreover, the IT Data Analyst is expected to possess a robust understanding of the claims adjudication process and apply statistical techniques when recommending courses of action, leveraging ...
... claims adjudication and case management processes. While training is provided, experience or willingness to learn is essential. Travel within Ohio is available, and candidates already on the BWC ...
Follow claims adjudication rules to assure that all claims are adjudicated in accordance with CMS rules and regulations and our Client's internal criteria * Review different lines of business to ...
Analyze and adjudicate a variety of claim types to include facility, professional, inpatient and outpatient services · Follow claims adjudication rules to assure that all claims are adjudicated in ...
Coordinates with Provider Data Contract Management and other pertinent departments to ensure all contractual language is configured correctly for accurate claims adjudication; and ensures pre-testing ...
Knowledge and proficiency in claims adjudication standards & procedures preferred. * Solid knowledge of Medicaid, Medicare, and pharmacy benefit laws and requirements; federal, state, civil and ...
They are primarily responsible for the processing functions (operation, adjudication, and payment) of UB-92 and HCFA-1500 claims that are received from PHP affiliated medical groups and hospitals for ...
Understanding of Health care claims adjudication processes, logic, and data. * Understanding of Health industry diagnosis, procedure and revenue codes and their application. * Proficient with ...
Three years of experience processing all types of group medical, dental and hospital claims; in-depth knowledge of benefits, claims adjudication principles and procedures, medical and/or dental ...
Technical Skills / Knowledge: · Understanding of health claims processing/adjudication · Ability to perform basic to intermediate mathematical computation routines · Medical terminology strongly ...
It includes providing necessary billing details to third-party payers for claims adjudication and ensuring that payments are received in accordance with contractual agreements. Additional ...
Screens claims for completeness of necessary information * Verifies participant/dependent ... adjudication environment * Working knowledge and experience in interpretation of benefit plans ...
The claims examiner is responsible for the adjudication of claims, in accordance with outside regulations and the contractual obligations of the Health Plans and/or the Hospital Client. Researches ...
This position has advancement opportunities in all areas, including, but not limited to, accounting, marketing, administration, sales, information systems, and claims adjudication. We are 100% onsite ...