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As the lead you manage internal and external applications to process Insurance business from ideation to launch for all areas of the business (claims, policy, mapping, quoting, accounting, marketing, etc.
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Familiarity with workers’ compensation industry practices and professional standards including but not limited to claims, utilization review, case management, medical bill review, pharmacy benefit management, ancillary care, PPO, and state-specific networks.
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This role will be seen as the subject matter expert on regulatory compliance across our managed care and claims organization. As the Compliance Director, you will be responsible for managing workers’ compensation regulatory risk by ensuring business operations are performing in compliance with federal, state, and local laws.
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Strong medical claims processing skills; PPO, Anthem JAA, Medicare and COB experience. · Solid understanding of CPT, HCPC, ICD9/10 coding, medical and claims terminology or solid knowledge of dental ADA procedure codes (CDT) and terminology.
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Filing claims, claims follow up, account audits, insurance questions and posting payments? Dental Insurance/Billing Specialist @ Advanced Dentistry South Florida Do you enjoy working with PPO dental insurance.
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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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Responsible for the collection of outstanding balances from all Commercial HMO PPO Medi-Cal & Managed Care payors professional claims. Responsible for follow up with payor on the routing of claims.
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While performing the duties of this job, the employee is frequently exposed to fumes or airborne particles, moving mechanical parts and vibration. Capable of traversing over construction-type terrain when under development; moving through the construction site and the materials in place for use on the site; climbing ladders and temporary stairways; conducting visual inspections of quality of construction and materials being used in construction.
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Withum is seeking an experienced health claims auditor possessing in-depth knowledge of group health and disability claims procedures, medical/dental terminology, including CPT, ADA, HCPC and ICDA codes, and a thorough understanding of automated health claims systems as well as manual claims payment systems.
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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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The Compliance Director will be responsible for the design, strategy, and management of an industry leading compliance program. Preferred certifications include Certified Compliance & Ethics Professional Certification (CCEP) or Certified Healthcare Compliance (CHC.
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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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Responsibilities include; stewardship of Patient Billing and Collection, A/R Management, Application Systems Support, Claims Management, Coding, Charge Capture, Data Entry, Account Follow-Up, Customer Service, Denial Management, Edit Management, Payment Variance Analysis, Contract Analysis, Credit Analysis, Refund Management, Payment Posting, Auditing, Training, and Productivity and Performance Reports.
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Process dental insurance claims, work with HMO and PPO dental plans, and present dental treatment plans to patients. Analyze and organize office operations and procedures, including but not limited to, bookkeeping, invoice processing, cash control, preparation of payrolls and other administrative duties.
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This position will be responsible for real time follow up on all denials, review of open/un-paid PPO Insurance claims, filing appeals and requesting additional needed information for assigned client offices.
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