The job profile for this position is Operations Senior Analyst, which is a Band 3 Senior Contributor Career Track Role. Excited to grow your career?We value our talented employees, and whenever possible strive to help one of our associates grow professionally before recruiting new talent to our open...
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...
Claims System Configuration Quality Review Senior Analyst - eviCore - Remote page is loaded Claims System Configuration Quality Review Senior Analyst - eviCore - Remote Apply remote type Remote locations Franklin, TN time type Full time posted on Posted 3 Days Ago job requisition id 24000625 Do you ...
Job Title: Systems Analyst, SpecialistJob Location: McLean, VA (100% telework permitted anywhere in the U.S.)Employer: Acentra Health, LLCJob Description: Collect data to analyze and implement multi-tenant Medicaid Management Information System (MMIS) Healthcare application. Gather requirements from...
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...
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...
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...
LTC PHARMACY BILLING TECHNICIAN - ADJUDICATION (2ND SHIFT) Job Details Level Experienced Job Location Northern IL Full-Time Remote - Chicago, IL Remote Type Fully Remote Position Type Full Time Education Level LPhT/CPhT Travel Percentage Negligible Job Shift 2nd Shift Job Category Billing **$1,000 S...
** Customer Service Representative, fully remote, Start date March 28th****Job Category****:** Customer Service **Requisition Number****:** CUSTO004889 Showing 1 location **Job Details****Description****Who We Are**is a leading not-for-profit health insurer in Wisconsin. Our services offer health in...
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...
**Resp & Qualifications****PURPOSE:**The Clinical Medical Review Nurse handles day to day review of professional and institutional claims and provider appeals that require medical review to determine if the claim is eligible for benefits and to support claims processing and/or adjudication. The incu...
Resp & QualificationsPURPOSE:The Clinical Medical Review Nurse handles day to day review of professional and institutional claims and provider appeals that require medical review to determine if the claim is eligible for benefits and to support claims processing and/or adjudication. The incumbent wi...
The ideal candidate in this role will be strong communicators, flexible in their methods, have a high level of empathy, are welcoming, have a willingness to learn and will be comfortable with technology tools. They will be experienced in providing phone-based customer service, and have basic compute...
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...
**Resp & Qualifications****PURPOSE:**The Clinical Medical Review Nurse handles day to day review of professional and institutional claims and provider appeals that require medical review to determine if the claim is eligible for benefits and to support claims processing and/or adjudication. The incu...
Resp & Qualifications PURPOSE: The Clinical Medical Review Nurse handles day to day review of professional and institutional claims and provider appeals that require medical review to determine if the claim is eligible for benefits and to support claims processing and/or adjudication. The incumbent...
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...
Supervise staff in their primary duties to collect on outstanding patient receivables, offer in-house financing options, resolve credit balances and reduce overall aged receivables. Maintain high team standards for work accountability and professionalism for our customers and within the Myriad organ...
Campus: DC-Washington-Union Center Plaza PURPOSE: The Clinical Medical Review Nurse handles day to day review of professional and institutional claims and provider appeals that require medical review to determine if the claim is eligible for benefits and to support claims processing and/or adjudicat...
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...