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Ability to interpret provider contracts and apply them to claims adjudication. Five or more years of healthcare claim processing experience in a managed care environment. Elevate the operational effectiveness of an award-winning healthcare leader.
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Position has primary responsibility for claims adjudication, claims payment and check processing for all healthcare claims and for assisting providers in troubleshooting claims issues. The Financial Operations Specialist is responsible for healthcare claims-processing related tasks.
Full-timeExpandApply NowActive JobUpdated 3 days ago - UpvoteDownvoteShare Job
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Intermediate to advanced understanding of pharmacy technology – included is product dispensing, data entry, and adjudication workflow step. KPH Healthcare Services, Inc. is a multistate organization and abides by all local, state and federal regulations as it pertains to minimum wage requirements.
$15 - $19.75 an hourExpandApply NowActive JobUpdated 4 days ago - UpvoteDownvoteShare Job
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As the client advocate to all Zelis departments, this role works to identify barriers and provide resolution and solutions through customer education, and coordination with healthcare payer and internal resources.
ExpandApply NowActive JobUpdated 10 days ago - UpvoteDownvoteShare Job
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Your healthcare industry knowledge in the areas of Formulary Management, Drug Utilization Management, and Reimbursement and Claims Adjudication will also contribute to your success. Your healthcare industry knowledge in the areas of Formulary Management, Drug Utilization Management, and Reimbursement and Claims Adjudication will also contribute to your success.
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Familiarity with Microsoft Office Suite Familiarity with healthcare benefits, pharmacy and medical terminology, and pharmacy claims adjudication process. Supporting the QI pharmacy initiatives, as well as disease state management functions of the pharmacy department; Providing drug related and benefit information to member services, provider relations, utilization management and medical directors; Supporting audit related activities; Evaluating and identifying aberrant prescribing patterns from prescription and medical claims data, with potential physician consultation; Creating and distributing physician and member educational materials.
$98,631ExpandApply NowActive JobUpdated 4 days ago - UpvoteDownvoteShare Job
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Zelis brings adaptive technology, a deeply ingrained service culture, and a comprehensive navigation through adjudication and payment platform to manage the complete payment process. We partner with more than 700 payers, including the top-5 national health plans, BCBS insurers, regional health plans, TPAs and self-insured employers, over 4 million providers, and 100 million members, enabling the healthcare industry to pay for care, with care.
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Required: Pharmacy/NDC medication billing, Pharmacy claims resolution, PBM and Medical contracts, knowledge/understanding of Medicare, Medicaid, and commercial insurance, NCPDP claim rejection resolution, coordination of benefits, pharmacy or healthcare-related knowledge, knowledge of pharmacy terminology including sig codes, and Roman numerals, brand/generic names of medication, basic math and analytical skills, Intermediate typing/keyboarding skills.
Full-timeExpandApply NowActive JobUpdated 6 days ago - UpvoteDownvoteShare Job
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Monitor changes in State and Federal laws, rules or fee schedules that impact medical bill review/re-pricing and ensure they are integrated into workflows (and Smart Advisor via Mitchell) for proper adjudication.
RemoteExpandApply NowActive JobUpdated 4 days ago - UpvoteDownvoteShare Job
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Send your completed complaint form or letter to us by mail at U.S. Department of Agriculture, Director, Office of Adjudication, 1400 Independence Avenue, SW, Washington, D.C. 20250-9410. The possibility exists of exposure to communicable disease due to working in a healthcare environment.
Full-timeExpandApply NowActive JobUpdated 5 days ago - UpvoteDownvoteShare Job
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We offer competitive rates, healthcare & dental, 401k, FSA, LTD, lots of voluntary benefits, and tons of discount perks. Develop and maintain complex consumer credit adjudication applications that operate in a high-availability environment.
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Familiarity with computerized medical billing or claims adjudication systems. Brighton Health Plan Solutions partners with self-insured employers, Taft-Hartley Trusts, health systems, providers as well as other TPAs, and enables them to solve the problems facing today’s healthcare with our flexible and cutting-edge third-party administration services.
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Is a go-to person on Claims & ID Card production, healthcare enrollment process & other product knowledge. As a leading payments company in healthcare, we guide, price, explain, and pay for care on behalf of insurers and their members.
Full-timeExpandApply NowActive JobUpdated 5 days ago - UpvoteDownvoteShare Job
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At GBS RevCycle, we're transforming healthcare with our comprehensive Revenue Cycle Management (RCM) solution. Reporting hindrances in payment/adjudication from insurance companies to the AR Team Lead is crucial.
ExpandApply NowActive JobUpdated 6 days ago - UpvoteDownvoteShare Job
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Professional and/or hospital claims adjudication experience, preferably in the healthcare/medical field. The Claims Examiner II will administer all claims adjudication processing professional and facility medical, dental and vision claims in accordance with regulatory guidelines and contractual agreements based on VIVA HEALTH guidelines.
Full-timeExpandApply NowActive JobUpdated 4 days ago
adjudication healthcare jobs
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