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We are looking for a motivated performer to join our Business Office team as a Collections Specialist, with an extensive knowledge of claims reimbursement and collection efforts for Managed Care, Medicare, Medicaid, Workers Comp, Commercial plans, etc.
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Minimum of 1 year of related claims processing experience in managed care/services, health plan, and/or IPA (preferred). Experience in adjudication of Commercial, Medicare Advantage, and Medi-Cal claims will make you a great candidate, along with experience or familiarity with Healthcare Service industry, Independent Physician Associates (IPAs), and/or have experience in a Managed Care/Service Organization (MSO) or Health Plan background.
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HMO Managed care Medicare Advantage experience. + Backup to the claims processing area by assisting with reports and workflow queues as assigned. We do this by aggregating massive amounts of clinical and claims data, applying algorithms to identify opportunities to provide better patient care, and making those opportunities actionable by physicians at the point of care in near-real time.
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Sante Health System provides numerous client services such as billing, claims processing, contracting, credentialing, finance, human resources, information services, marketing/communications, physician services, practice management, provider relations, quality improvement, and utilization management.
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Meets with Managed Care payers Contracting and PFS follow-up staff as necessary to resolve disputes related to accounts receivable and to discuss changes in contracts. Under the general direction of the Director Contracting Analytics and Modeling perform all duties necessary to properly identify and process recovery of revenue for Contract Management and Managed Care denials for Lifespan and its Rhode Island affiliates.
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Minimum of 5-10 years’ of experience and relevant knowledge of revenue cycle functions and systems working within a hospital or clinic environment, a health insurance company, managed care organization or other health care financial service setting, performing medical claims processing, financial counseling, financial clearance, accounting or customer service activities or an equivalent combination of education and experience.
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Five (5) years’ experience and knowledge of HMO, PPO, TPA, PHO and Managed Care functions (e.g. accounting/finance, reinsurance, EDI, marketing, administration, medical delivery, regulatory compliance, claims processing, membership/eligibility, contracting and risk arrangements and actuarial precepts.
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Understanding of claims processing rules, managed care benefits, and adjudication. Ensure quality processing of various types of claims (e.g., in/outpatient hospital claims, Medi-cal, Commercial, and Medi-care claims.
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3 - 5+ years' claims processing experience, preferably working in an HMO, managed care or self-insured environment (Required) Knowledge of claims processing rules and coding experience with DRG, ICD10 and CPT4 (Required.
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Description The Billing Specialist is responsible for ensuring accurate billing, timely submission of electronic and/or paper claims, monitoring claim status, researching rejections and denials, documenting related account activities, posting adjustments and collections of Medicare, Medicaid, Medicaid Managed Care, and commercial insurance payers.
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Escalate data processing and/or customer service needs to Claims Supervisor and/or Assistant Director of Managed Care, as necessary. Previous experience with claims processing and/or data entry is preferred.
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The Senior Claims Examiner will adjust workers’ compensation claims from inception through settlement and closure, ensuring timely processing of claims and payment of benefits, managing, and directing medical treatment, setting reserves, and negotiating settlements.
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MyEyeDr. is a high-growth, premier healthcare company: a total vision care concept with a unique retail experience. The Revenue Cycle Administrator is responsible for facilitating the efficient and accurate submission of insurance claims to various vendors, to ensure that the organizations receivable accounts are credited in a timely manner.
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Two years of experience with clinical documentation, chart reviewing, utilization review, managed care, and/or claims denials and appeals processing required. Knowledge of claims denials and appeals processing.
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They are primarily responsible for the processing functions (operation, adjudication, and payment) of UB-92 and HCF1500 claims that are received from PHP affiliated medical groups and hospitals for HMO patients.
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claims processing managed care jobs
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