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Drives Operational metrics, including but not limited to the following: productivity, VBP, SVP, ACH, claims alert, late EMS, unverified services, orders audit, and agency financial statements to ensure the organization is on target with company goals related to operational efficiency, growth, quality, and finances.
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The position will oversee and manage the Vendor Management team responsible of managing and coordinating the vendor activities between contracted entities and Molina Healthcare to support enrollment, claims, contact center, appeals and grievances, risk adjustment, medical records, quality, Provider and/or other functions under operations across multiple states and lines of business.
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Responsible for processing customer bills and insurance claims in an accurate and timely manner. Perform prescription claims adjudication including communication with insurance companies regarding rejected claims, eligibility, prior authorizations or other issues as needed.
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To Credit; Cash Applications; Claims; Pricing Execution; Billings; Deductions; Accounts Payable; and Sales. Facilitate development and tracking of team metrics, and miscellaneous ad hoc support of AR Analyst and/or.
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Respond to ad-hoc reporting and analytic requests from internal stakeholders by mining data using SQL, Python, business intelligence tools, and claims databases. Independently mine claims and digital data to clearly understand capabilities and limitations of the data for analyses.
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Review and process switchgear warranty claims. Provide feedback regarding design of switchgear systems, including but not limited to, PLC and HMI programming, circuit design, sequence of operation, etc.
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Strong understanding of revenue cycle processes, including charge capture, claims processing, payment posting, and accounts receivable management. Oversee the day-to-day operations of the outpatient billing department, including charge capture, claims submission, payment posting, and accounts receivable management.
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Crafting professional appeals in response to denied claims or payer audit requests. · Collaborating closely with Accounts Receivable and Case Management to ensure claims are paid appropriately and in a timely manner.
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The Senior EDI (Electronic Data Interchange) Claims Specialist will provide analysis and support to the EDI Claims Coordinator in processing inbound and outbound EDI claim transactions. Assist the EDI claims coordinator with implementing new claims related EDI transactions.
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Maintains the Sales Floor in accordance with Company policies and procedures by properly handling claims and returns, zoning the area, arranging and organizing merchandise, and identifying shrink and damages.
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Processes (corrects and resubmits) manual claims for third party program prescription services in a timely and efficient manner, and performs other clerical duties, as assigned by the Pharmacy Manager.
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We use best-in-class ticket and claims management systems to ensure clear and complete mark-out services for the excavator or property owner at the work site. Correctly, safely, and efficiently locate underground utilities, including telecommunications, electric power, cable TV, gas, water, and sewer systems.
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Troubleshoot rejected insurance claims and address issues to achieve the best outcome for customers. Troubleshoot rejected insurance claims and address issues to achieve the best outcome for customers.
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Maintains the Sales Floor and merchandise presentation in the Freezer/Cooler/Deli area in accordance with Company policies and procedures by properly handling claims and returns; zoning the area; receiving and stocking merchandise; setting up, cleaning, and organizing product displays; removing damaged goods; signing and pricing merchandise appropriately; completing required audits, paperwork, logs, and other required documentation; and securing fragile and high-shrink merchandise.
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Use written and verbal communication skills to interact with Global Treaty's Internal (Claims, Underwriting, etc.) Responsibilities: An outstanding opportunity exists for a student seeking to gain marketable financial skills and experience in the exciting area of International Reinsurance and Finance in a team-oriented environment.
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