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Industry experience with dental claims, provider relations, Medicare Advantage. Manage PPO and Medicare Advantage recruitment efforts and network retention within assigned territories. Ideal candidates will demonstrate a track record of success in Dental PPO Networks and/or Dental third-party networks.
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This position presents a distinctive chance to craft top-tier recruitment strategies aligned with our expanding Medicare Advantage Network. Proven negotiation and relationship building skills – continuing positive relationships with dental providers, large dental groups, DSO’s, and Dental Consultants.
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Identify, recruit, negotiate, and contract a dental provider network in a geographic area within established targets. 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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Process and track Workers’ Compensation claims. Golden Valley Health Centers offers excellent benefits including Medical: (0 Deductible / $2,000 Individual; $4,000 Family Out-of-Pocket Max), excellent PPO coverages; Dental; Vision; 403(b) with match, FSA plans, gym discounts, and so much more.
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As our Director of Specialty Bill Review Services, you will maximize savings and client satisfaction by providing strategic direction for Rising's Specialty Services unit involving complex/large medical claims; analyzing and optimizing bill review procedures and systems; and leading a team of experienced medical bill review auditors, nurse auditors, med-legal nurse, negotiators and related staff in an environment of continual performance improvement.
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The most common branded health lines of business included in the Program are: HMO, PPO, Indemnity, Traditional, Medicare Advantage, Medicare Supplemental products, Medicare Replacement products, and Medicaid.
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Identify the elements of project design and construction likely to give rise to disputes and claims. Group medical, vision and dental insurance including choice of two benefit plans – a PPO plan and a high deductible / Health Saving Account Plan with company contribution to HSA.
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Three 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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Research and answer complex questions regarding CPT, ICD-9, HCPC and other codes, fee schedules, PPO applications, and other technical matters. Minimum five years of financial analysis/business, medical claims adjusting background preferably in Workers Compensation with progressive management responsibility.
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Requirements Medical Billing, Medical Collections, Medical Appeals, Medical Denials, HMO - Health Maintenance Organization, PPO - Preferred Provider Organization, Hospital Inpatient, Hospital Revenue Cycle.
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May provide support to the Risk Management Coordinator and risk management program in providing back up to claims calls (including intake) for auto/property/liability claims. + Medical - Choice of Regence BlueShield (PPO) or Kaiser Permanente (HMO) plans offered through the Association of Washington Cities (AWC) Trust.
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Medical, Dental and Vision plans (PPO and HSA plans available); Individual and Family coverage offerings. This Business Analytics Lead Analyst will join the Clinical Research organization, specializing in delivering direct analytical support for the Clinical Product Portfolio, utilizing various data types, including medical and pharmacy claims.
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FEP is a National Plan, so BSC members under the FEP PPO program have the same benefits in all states. You will provide direct support for professional services claims, and partner with (other agencies) Anthem to resolve member issues relating to facility claims.
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We partner with more than 700 payers, including the top-5 national health plans, BCBS insurers, regional health plans, TPAs and self-insured employers, over 4 million providers, and 100 million members, enabling the healthcare industry to pay for care, with care.
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Is an entry level position in the Enterprise Grievance & Appeals Department that reviews, analyzes and processes non-complex pre service and post service grievances and appeals requests from customer types (i.e. member, provider, regulatory and third party) and multiple products (i.e. HMO, POS, PPO, EPO, CDHP, and indemnity) related to clinical and non clinical services, quality of service, and quality of care issues to include executive and regulatory grievances.
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