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Address and resolve registration-related issues such as insurance verification, demographic updates, and eligibility discrepancies to ensure accurate billing and claims processing. Monitor claim status, identify and resolve claim rejections, denials, and pending issues to expedite payment processing.
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Provide Knauf employees and/or dependents with advice, counsel, and help in all aspects of benefits including enrollment and claims processing; serve as liaison for Knauf with the TPA benefit vendor and the administration of employee claims; coordinate benefit changes with the Payroll.
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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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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 Business Intelligence Developer ideally has experience with leading healthcare technology systems such as EMR (Epic), Claims processing (Epic), ERP (Workday), CRM, cloud based data platforms (Azure, Snowflake) etc.
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Oversight of Medicaid claims, Tricare and Coverage Gap processing operations with Third Party vendor and coordination of quarterly cash flow monitoring with Treasury. Insure approval workflow of Medicaid, Tricare and Coverage Gap claims follows approval matrix and completes within payment due date cycle.
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Knowledge of claims processing and the various fields submitted with a claim such as Universal Medical Billing. Supports all inbound and outbound data loads that are aligned with the Analytics team (e.g., Medical Claims ingestion, Lab Data ingestion, Milliman input/output, IINT input/output, IPro input/portal, Mt Sinai outbound data, ad hoc claims extracts etc.
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Experience in supporting the infrastructure / application environment within a CMS Claims Processing Environment for Part A, Part B and DME Claims. Experience in network security (Cisco ASA, IPS, VPN, RSA SecurID, PKI, cryptography), security controls for LAN/WANs, client server, web-based systems, and databases.
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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.
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A Grant Revenue Cycle Biller contributes to AHF by reviewing and processing claims daily, making necessary updates based on specific grant requirements. A Grant Revenue Cycle Biller enhances the reputation of AHF by displaying proper and timely knowledge and submission, being flexable and adaptive.
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The Default Servicing Processor support the Default Management department in the processing and tracking of Broker Price Opinions (BPOs), Automated Valuation Models (AMVs), inspections, property preservation, loss mitigation/workouts, bankruptcies, foreclosures, claims, and modification processing.
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Processing of time sensitive authorization and pre-certification requests to meet department timeframes and regulatory requirements; Computer Input: Accurately and completely process referrals/authorizations in the UM system of record; Identify duplicate requests using claims to verify existing authorization.
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The Change Manager will assist LACMTA Contract Administration with processing changes to the construction contract; coordinating technical documents, Requests for Change (RFC), and Cost and Schedule Proposal (CSP) analysis with the Resident Engineer, Project Controls Manager, and Change Committee; obtaining 3rd party review concurrence when necessary; and providing technical support on preparation of contract changes.
$94,760 - $166,750 a yearFull-timeExpandApply NowActive JobUpdated Today - UpvoteDownvoteShare Job
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Reports to client regarding reimbursements and in turn forwards to accounting department for reimbursementMaintains quality client service by responding timely and accurately to client inquiries maintaining client expected turn-around timePrepares standard and ad hoc reportsMaintains confidentiality and comply with Health Insurance Portability and Accountability Act (HIPAA)Requirements: College degree or a minimum of five (5) years medical stop loss claims processing.
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Minimum of 3 years of experience in benefits administration, leave management, and workers' compensation claims processing, preferably in a corporate environment. As the Employee Benefits and Leave Manager, you will play a critical role in overseeing all aspects of employee benefits programs, leave management, and workers' compensation claims.
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