Do you want to Drive Growth and Change Lives? EviCore, a division of the Cigna Group is hiring a Claims Systems Configuration Quality Review Senior Analyst. This role requires the review of our claims system to ensure all configurations were input correctly per the specifications of the provider. Th...
A large healthcare client is looking for a Claims Analyst to work REMOTELY on their configuration and support team. This team is fully responsible for end-to-end operational performance of core business systems utilized by internal operations staff and insurance customers. These responsibilities inc...
REMOTE CLAIMS ADMINISTRATOR - WFH IN PACIFIC TIME Do you want to be part of a Company that helps people achieve lifetime financial security and live healthier lives worldwide? While working from the comfort of your home? If you have Claims experience this is your opportunity. APPLY NOW and join us....
The CSI Companies is actively seeking a Remote Audit Senior Consultant for our well known client, an accounting organization and one of the largest professional service networks in the world. The CSI Companies understands that an attractive benefits package is important for recruiting above-average...
The CSI Companies is actively seeking a Remote Audit Senior Consultant for our well known client, an accounting organization and one of the largest professional service networks in the world. The CSI Companies understands that an attractive benefits package is important for recruiting above-average...
Job Description Job Description Must understand Medicaid EligibilityMaybe previous state of Maryland job experienceMedicaid enrollmentAble to query very complex data setsArticulate to the businessWork very closely with the customerRetro eligibilityEx. State makes people eligible into the pastThen ma...
UnitedHealthcare is a company that's on the rise. We're expanding in multiple directions, across borders and, most of all, in the way we think. Here, innovation isn't about another gadget, it's about transforming the health care industry. Ready to make a difference? Make yourself at home with us and...
UnitedHealthcare is a company that's on the rise. We're expanding in multiple directions, across borders and, most of all, in the way we think. Here, innovation isn't about another gadget, it's about transforming the health care industry. Ready to make a difference? Make yourself at home with us and...
Plans, conducts, and directs the analysis of both internal and external business problems to be solved with automated systems. Works with clients to develop analyses for the purpose of pre-sale software evaluation, claims editing optimization, or ad hoc reporting. Leads analytic engagements for a...
Plans, conducts, and directs the analysis of both internal and external business problems to be solved with automated systems. Works with clients to develop analyses for the purpose of pre-sale software evaluation, claims editing optimization, or ad hoc reporting. Leads analytic engagements for a...
Plans, conducts, and directs the analysis of both internal and external business problems to be solved with automated systems. Works with clients to develop analyses for the purpose of pre-sale software evaluation, claims editing optimization, or ad hoc reporting. Leads analytic engagements for a...
Plans, conducts, and directs the analysis of both internal and external business problems to be solved with automated systems. Works with clients to develop analyses for the purpose of pre-sale software evaluation, claims editing optimization, or ad hoc reporting. Leads analytic engagements for a...
Plans, conducts, and directs the analysis of both internal and external business problems to be solved with automated systems. Works with clients to develop analyses for the purpose of pre-sale software evaluation, claims editing optimization, or ad hoc reporting. Leads analytic engagements for a...
Job Description Senior Claims Examiner/Auditor UST HealthProof is looking for Sr. Claims Examiner, reporting to the Claims Team Leader; the Examiner is responsible for the adjudication of healthcare claims utilizing group and payer-specific policies and procedures. Responsible for reviewing the...
Description:+ Ensures accurate adjudication of claims, by translating medical policies, reimbursement policies, and clinical editing policies into effective and accurate reimbursement criteria.+ Reviews company specific, CMS specific, and competitor specific medical policies, reimbursement policies,...
We are seeking a Product Owner / Business Analyst who will be responsible for documenting process flow and requirements for our healthcare insurance claims adjudication application. In this role, you will be working with key architects, engineers and business partners to ensure that business, quali...
Job Description About Conduent Through our dedicated associates, Conduent delivers mission-critical services and solutions on behalf of Fortune 100 companies and over 500 governments – creating exceptional outcomes for our clients and the millions of people who count on them. You hav...
Company DescriptionAt PopHealthCare, our mission is simple - to lead the effort in reimagining how healthcare is delivered. We are bold innovators, dedicated to making a difference and we hire wicked smart people!Job DescriptionAt PopHealthCare, our mission is simple - to lead the effort in reimagin...
Job DescriptionIn this Role you will be Responsible for :• Reviewing and researching insurance claims to determine possible payment accuracy.• Validating Member, Provider and other Claims information.• Determining accurate payment criteria for clearing pending claims based on defined Policy and Proc...
In this Role you will be Responsible for :• Reviewing and researching insurance claims to determine possible payment accuracy.• Validating Member, Provider and other Claims information.• Determining accurate payment criteria for clearing pending claims based on defined Policy and Procedure.• Coordin...
Essential Duties & Responsibilities • Process encounters and post charges daily.• Verifies completeness and accuracy of all claims prior to submission to carriers and clearing houses• Communicate with clinic staff to ensure proper coding of records prior to submission• Review file data batches and s...
Description:This position will be 100% remote Daily Duties:Ensures accurate adjudication of claims, by translating medical policies, reimbursement policies, and clinical editing policies into effective and accurate reimbursement criteria. Reviews company specific, CMS specific, and competitor specif...
Combine two of the fastest-growing fields on the planet with a culture of performance, collaboration and opportunity and this is what you get. Leading edge technology in an industry that's improving the lives of millions. Here, innovation isn't about another gadget, it's about making health care dat...
Job Description Must be local to Colorado. Remote work. (Must move to CO if not in CO) BA positions are responsible for implementing system changes for the PBMS, Business Intelligence Data Management (BIDM) and Colorado Interchange (iC) related to prescription drug benefits. They will demonstrate ex...
UnitedHealthcare is a company that's on the rise. We're expanding in multiple directions, across borders and, most of all, in the way we think. Here, innovation isn't about another gadget, it's about transforming the health care industry. Ready to make a difference? Make yourself at home with us and...
UnitedHealthcare is a company that's on the rise. We're expanding in multiple directions, across borders and, most of all, in the way we think. Here, innovation isn't about another gadget, it's about transforming the health care industry. Ready to make a difference? Make yourself at home with us and...
-Working as an effective team member in an Agile Scrum or Kanban team.-Providing technical expertise and mentoring to their fellow Agile team members and members of other teams.-Gather and analyze complex business requirements.-Specify and implement technical plans for complex solutions.-Combine bus...
Description:This position will be 100% remote Daily Duties:Ensures accurate adjudication of claims, by translating medical policies, reimbursement policies, and clinical editing policies into effective and accurate reimbursement criteria. Reviews company specific, CMS specific, and competitor specif...
RPG Technical Lead Location: Hartford, CT/Remote Duration: Contract Rate: DOE US Citizens and Green Cards Preferred. No Third party Corp to Corp What You Will Do: Provide leadership and direction to the development team. Lead status meetings with the development and manageme...
You’ll enjoy the flexibility to telecommute* from anywhere within the The health care system is still evolving at a rapid pace. Technology is driving new advances in how patient care is delivered and how it’s reimbursed. Now, UnitedHealth Group invites you to help us build a more accurate and...
Combine two of the fastest-growing fields on the planet with a culture of performance, collaboration and opportunity and this is what you get. Leading edge technology in an industry that's improving the lives of millions. Here, innovation isn't about another gadget, it's about making health care dat...
Company DescriptionAt PopHealthCare, our mission is simple - to lead the effort in reimagining how healthcare is delivered. We are bold innovators, dedicated to making a difference and we hire wicked smart people!Job DescriptionAt PopHealthCare, our mission is simple - to lead the effort in reimagin...
Company DescriptionAt PopHealthCare, our mission is simple - to lead the effort in reimagining how healthcare is delivered. We are bold innovators, dedicated to making a difference and we hire wicked smart people!Job DescriptionAt PopHealthCare, our mission is simple - to lead the effort in reimagin...
About ParadigmParadigm is an accountable care management organization focused on improving the lives of people with complex and catastrophic injuries and diagnoses. We have been a pioneer in value-based care since 1991, offering deep clinical expertise, high-value specialty networks, behavioral heal...
About ParadigmParadigm is an accountable care management organization focused on improving the lives of people with complex and catastrophic injuries and diagnoses. We have been a pioneer in value-based care since 1991, offering deep clinical expertise, high-value specialty networks, behavioral heal...
The Senior IT Project Manager defines, plans, and delivers of complex programs that require cross-functional collaboration and management of inter-dependencies between a group of projects and/or related activities within the constraint of scope, quality, time and budget. Includes the management of a...
Combine two of the fastest-growing fields on the planet with a culture of performance, collaboration and opportunity and this is what you get. Leading edge technology in an industry that's improving the lives of millions. Here, innovation isn't about another gadget, it's about making health care dat...
Responsible for validating dispute reasons following Explanation of Benefits (EOB) review, escalating payment variance trends or issues to NIC management, and generating appeals for denied or underpaid claims. ESSENTIAL DUTIES AND RESPONSIBILITIES - Include the following. Others may be assigned. Val...
Job Description The Analyst is responsible for accurately coding, testing and maintaining managed care contracts from assigned facilities into the contract management system in conformance with the language of the legal document. The Contract Analyst also works with expression building tools a...
Los Angeles , CA | Work from home flexibility Posted: 03/13/2024 Industry: Laboratory - Food & Beverage Job Number: 73.24KK Pay Rate: 90,000 - 105,000 Experience: Job Description Regulatory Affairs Analyst The Regulatory Affairs (RA) Analyst is responsible for ensuring compliance of raw material doc...
Senior Claims Examiner/Auditor UST HealthProof is looking for Sr. Claims Examiner, reporting to the Claims Team Leader; the Examiner is responsible for the adjudication of healthcare claims utilizing group and payer-specific policies and procedures. Responsible for reviewing the data in the claims...
Senior Claims Examiner/AuditorUST HealthProof is looking for Sr. Claims Examiner, reporting to the Claims Team Leader; the Examiner is responsible for the adjudication of healthcare claims utilizing group and payer-specific policies and procedures. Responsible for reviewing the data in the claims pr...
You’ll enjoy the flexibility to telecommute* from anywhere within the Welcome to one of the toughest and most fulfilling ways to help people, including yourself. We offer the latest tools, most intensive training program in the industry and nearly limitless opportunities for advancement. Join u...
You’ll enjoy the flexibility to telecommute* from anywhere within the Welcome to one of the toughest and most fulfilling ways to help people, including yourself. We offer the latest tools, most intensive training program in the industry and nearly limitless opportunities for advancement. Join u...
If you are located in Norristown, PA you will have the flexibility to telecommute* as you take on some tough challenges.Healthcare isn't just changing. It's growing more complex every day. ICD - 10 Coding replaces ICD - 9. Affordable Care adds new challenges and financial constraints. Where does it ...
If you are located in Norristown, PA you will have the flexibility to telecommute* as you take on some tough challenges.Healthcare isn't just changing. It's growing more complex every day. ICD - 10 Coding replaces ICD - 9. Affordable Care adds new challenges and financial constraints. Where does it ...
PRIMARY PURPOSE : To analyze complex or technically difficult workers' compensation claims to determine benefits due; to work with high exposure claims involving litigation and rehabilitation; to ensure ongoing adjudication of claims within service expectations, industry best practices and spec...
** Remote Texas Experienced Claims Level III Adjuster****Job Category****:** Claims **Requisition Number****:** EXPER001447 Showing 1 location **Job Details****Description****About Our Texas Experienced Claims Level III Adjusters:**Level III Claims Adjusters at Elephant are our mid to senior level c...
** Remote Texas Experienced Claims Level III Adjuster****Job Category****:** Claims **Requisition Number****:** EXPER001447 Showing 1 location **Job Details****Description****About Our Texas Experienced Claims Level III Adjusters:**Level III Claims Adjusters at Elephant are our mid to senior level c...
** Remote Texas Experienced Claims Level III Adjuster****Job Category****:** Claims **Requisition Number****:** EXPER001447 Showing 1 location **Job Details****Description****About Our Texas Experienced Claims Level III Adjusters:**Level III Claims Adjusters at Elephant are our mid to senior level c...