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Knowledge and experience with Medicaid, managed care, MMIS, health claims payment and processing, population health management, or other similar areas | Highly desired. Job Title- Test Lead Engineer Location- 2MLK Jr Dr, SE West Tower - 16th Floor (Hybrid) The Georgia Department of Community Health (DCH) is in the process of transforming existing legacy Medicaid Enterprise Systems (MES) into modern, loosely coupled, seamlessly integrated, modular systems where the exchange of data and processes is seamless and automatic.
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ARM will serve as the key contact and lead for access and reimbursement support-related matters and is responsible for being the local market access expert on payer policy coverage, multi-channel acquisition pathways, billing and coding, claims processing, reimbursement, and integration of manufacturer support programs into a range of account workflows.
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The Sr. Claims Adjudicator will be responsible for reviewing medical claims for accuracy and completeness, analyzing complex CCI and CMS edits, making determinations on claims based on established policies and procedures and processing claims for payment.
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Compiles and organizes medical records; distributes to Medicare Compliance nurses for analysis; and provides guidance and advice on processing claims based on nurses’ analysis. Analyzes lien notices for accuracy, communicates with the CMS to efficiently facilitate lien resolutions on claims and/or prepare MSA submissions in accordance with submission guidelines from CMS as assigned.
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Reporting to the National Account Manager for Costco, you will be responsible for overseeing sales forecasting and order processing, liaising between The Cookware Company (CWC) and retail customers to ensure timely deliveries, and leveraging data to identify gaps and order needs.
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Monitors unemployment claims by reviewing and processing required paperwork expeditiously and keeping VP of Human Resources abreast of progress in claims. Manages leave of absence requests from employees including processing proper documents related to FMLA, STD, etc.
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Objectives may include new distributor onboarding, training, call center management, post issue servicing, licensing, and appointment, and/or claims processing. Objectives may include new distributor onboarding, training, call center management, post issue servicing, licensing, and appointment, and/or claims processing.
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The A/R Billing Clerk position is responsible for validating patient's insurance coverage, processing recurring rentals, claims coding, claims billing including price validation, assisting patient accounts with billing discrepancies, payment posting and working denials in CareTend management software.
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In the role of Premium Audit Manager (internally known as "Manager, Premium Audit"), you will manage the day-to-day operations of a processing team to meet the established standards for timely physical and voluntary audits.
$73,000 - $117,000 a yearFull-timeExpandApply NowActive JobUpdated Today - UpvoteDownvoteShare Job
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The Insurance Billing Specialist's primary job function is to ensure accurate and timely processing of insurance claims and payments and create Good Faith Estimates. Strongly prefer knowledge of diagnosis and procedural coding, medical terminology, and insurance billing guidelines, fluent with industry X12 and ANSI guidelines, proficient with claims adjustment reason and remark codes (CARC and RARC), FQHC certification or billing experience.
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The Senior Fiscal Coordinator will ensure the accurate processing of Operations invoices from Vendors, in preparation for electronic fund transfer and check runs, Intermediate Care Facilities - State Plan Amendment (ICF - SPA) Processing, and State Claims Processing each month.
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Manage utilization review, translation of foreign claims, coordination of benefits (COB), and processing of claims with unique processing arrangements including Federal Employee Program (FEP) and Medicare Advantage.
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Follow established policies and practices to resolve questions and issues on employee (disability) claims using resource information on policies, plans, employee data and claim data from the vendor.
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Manage claims specialist, ensuring proper and timely claims processing. Process insurance claims by gathering information from client, submitting to insurance company, and following through to the close of the claim with claims adjuster.
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Requires hands-on familiarity with the government's office and network environment, including but not limited to, data processing environments, including office automation networks, PC-based databases and other applications, internet and server-based databases and other applications, such as Oracle, Relativity or other document review platform, Trial Director, et cetera or similar applications/databases.
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claims processing jobs
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