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Three or more years of experience in Epic/Tapestry system claims adjudication and provider contract configuration required. Seven or more years of experience in health plan claims adjudication and provider contract configuration/analysis required.
$67,400 - $133,400 a yearFull-timeExpandApply NowActive JobUpdated 4 days ago - UpvoteDownvoteShare Job
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Working knowledge of Employee Retirement Income Security Act of 1974 (ERISA) claims processing/adjudication guidelines. Claims Examiner I is responsible for reviewing and processing medical, dental, vision and electronic claims in accordance with state, federal and health plan regulatory requirements, department guidelines, as well as meet established quality and production performance benchmarks to include research and review of applicable documentation.
$33,280 - $47,271 a yearFull-timeExpandApply NowActive JobUpdated 21 days ago - UpvoteDownvoteShare Job
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Assists other departments, when requested: a) Claims Processing and Operations, b) Provider and Member Services, c) Grievances/Appeals, d) HR/Onboarding/Interviews, e) Quality Management, f) Peer review, and g) Providing findings to the claims processing team and/or adjudication of claims related to Orthodontic cases.
ExpandApply NowActive JobUpdated 5 days ago - UpvoteDownvoteShare Job
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Accurately assess claims and identify any problematic issues associated with adjudication that may impact upstream billing to payers. Provide follow up with payers or internal claims processing team on denied or unpaid claims as applicable to the root cause of the denial; this could be an insurance plan error or internal processing such as in the case of coordination of benefits or billing configuration.
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The incumbent will be responsible for following regulatory and internal guidelines in conjunction with CalOptima Health's policies and procedures that apply to claims adjudication and adjustment of claims.
Full-timeExpandApply NowActive JobUpdated 7 days ago - UpvoteDownvoteShare Job
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Area’s of Medicare Part D rules and regulations, Medicaid services, claims adjudication process, CMS guidance, and the life cycle of PDE data. Strong ability to translate existing and non-existing business processes to technical requirements including metadata profiling, understanding SDLC, and the processing of ELT functions.
RemoteExpandApply NowActive JobUpdated 4 days ago - UpvoteDownvoteShare Job
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Completes all non-medical claims adjudication (Home health services, ALF, nursing Home) to include verifying claims and incidental charges, flags and researches questionable bills, prints remittance advice and check requests.
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The Benefit Configuration Tester I test’s configuration and maintenance activities of Navitus Benefit Configuration Analysts (BCA) who are responsible for the configuration of Navitus’ pharmacy claims processing system.
Full-timeRemoteExpandApply NowActive JobUpdated 12 days ago - UpvoteDownvoteShare Job
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Payment integrity, claim processing and/or revenue cycle for healthcare claims. Zelis brings adaptive technology, a deeply ingrained service culture, and a comprehensive navigation through adjudication and payment platform to manage the complete payment process.
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Ability to work under pressure and adapt to changing environmentWorking knowledge of Employee Retirement Income Security Act of 1974 (ERISA) claims processing/adjudication guidelines.
RemoteExpandApply NowActive JobUpdated 4 days ago - UpvoteDownvoteShare Job
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Combine in-depth analysis of business unit requirements and comprehensive understand of core system capabilities, knowledge of claim processing, provider and vendor setup, authorizations and business processes in order to determine optimal core system setup to process claims, case management, and grievance and appeals with a high degree of accuracy and auto-adjudication.
ExpandApply NowActive JobUpdated 10 days ago - UpvoteDownvoteShare Job
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Advance level (minimum 5 years) of claims processing experience and understanding of medical, dental, FSA, HRA, transplant, coordination of benefits, Medicare, hospital, professional, subrogation, and accident claims required.
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The Senior Claims Specialist is responsible for the processing of complex institutional claims (stop loss, contracted, non-contracted, per diem, case rate etc.) Senior Claims Specialist must have knowledge of compliance issues as they relate to claims processing and ability to identify and address non-contracted providers.
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We are seeking a skilled and experienced COBOL Developer with expertise in healthcare claims processing to join our team. Proven experience as a COBOL Developer with a focus on healthcare claims processing.
ExpandApply NowActive JobUpdated 3 months ago - UpvoteDownvoteShare Job
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Reviews pre-specified claims or claims that exceed specialist adjudication authority or processing expertise. Reviews and adjudicates complex, sensitive, and/or specialized claims in accordance with plan processing guidelines.
$18.5 - $35.29 an hourFull-timeExpandApply NowActive JobUpdated 1 month ago
claims processing adjudication jobs
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