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For nearly two decades, Wexford Health has consistently delivered proven staffing expertise and a full range of medical, behavioral health, pharmacy, utilization management, provider contracting, claims processing, and quality management services.
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The position will ensure that claims processing procedures and controls are being followed by all Claims department personnel. We are seeking a qualified candidate for the Claims Processing Supervisor position.
ExpandApply NowActive JobUpdated 9 days ago - UpvoteDownvoteShare Job
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Experience working with managed care claims, third-party liability, Medicaid waiver programs, and provider enrollment; Knowledge and expertise in managed care claims, third-party liability, Medicaid waiver programs, and/or provider enrollment.
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This position is primarily responsible for adjudicating all medical and non-medical provider claims and submitting enrollments/disenrollment to Florida Medicaid and CMS. Position is key to PACE's revenue and expense process, procuring Medicare rate tables, processing provider claims for expenses by service line, ensuring client enrollment for accurate capitation reimbursement from Medicaid and Medicare, generating accruals for Accounting.
ExpandApply NowActive JobUpdated 4 days ago - UpvoteDownvoteShare Job
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Job Summary Hybrid Work Environment - Must reside on Oahu Pay Range: $53,996 - $79,258 Note: Individuals typically begin between the minimum to middle of the pay range Manages both individual and group provider relationships with HMSA to include provider recruitment, standard contracting, onboarding, claims training and resolution of providers' issues including those related to claims payment, quality and performance initiatives, improved access and controlling unnecessary costs.
$53,996 - $79,258 a yearExpandApply NowActive JobUpdated Yesterday - 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.
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The Billing Representative II is responsible for performing a variety of duties related to patient account billing for professional provider claims and processing of accounts receivable for Cooley Dickinson Medical Group (CDMG.
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The Senior Claims Examiner will work on special projects related to provider and plan documents, system upgrades, implementing initiatives to improve claims processing, and turnaround times.
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The responsibilities of the Bilingual Claims Examiner consist of processing claims data and adjudicating medical and inpatient claims received from all provider types and lines of business, reviewing and resolving rejected and/or denied claims, conducting research and analysis of claims and facilitating resolution of specific claims issues.
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Oversee extracting and collecting diagnosis data from claims systems, submitting this data in the form of Medicare Risk Adjustment Processing System (RAPS) files to CMS in a timely manner, and oversee the RAPS record error correction processes.
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Exists to manage and enhance computerized claims processing and information management systems in order to assure timely and accurate Medicaid and Child Health Plan Plus (CHP+) claims processing and payments in an environment of rapid policy change.
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They will work closely with Provider Contracting, Medical Management, Enrollment and Membership department, and Claims Processing unit. Minimum 2 years of experience in claims processing protocols and payment schemes.
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Familiarity with CPT, HCPCS, ICD-10 coding, revenue codes, and hospital billing/claims processing. Experience with net revenue, Crowe revenue analytics tool, and provider enrollment.
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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.
$18 - $22 an hourExpandApply NowActive JobUpdated 4 days ago - UpvoteDownvoteShare Job
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The company also provides managed care services, including claims processing, stop-loss insurance, provider network access, medical management, care management and wellness programs, actuarial services, and other administrative services.
Full-timeExpandApply NowActive JobUpdated 3 months ago
claims processing provider jobs
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