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Experience with Pharmacy claim adjudication. Understanding of Medicaid PDL (for generic and brand drugs), preferred/non-preferred drug, prior authorization criteria/rules, lock-in program requirements and drug utilization review (both ProDUR and RetroDUR.
Full-timeExpandApply NowActive JobUpdated 1 days ago - UpvoteDownvoteShare Job
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The Risk Manager I manages the creation, implementation and validation of various risk segmentation strategies including, but not limited to: adjudication, account management, exposure management, risk segmentation, and financial return optimization.
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To analyze bodily injury claims on behalf of our valued clients to determine benefits due, while ensuring ongoing adjudication of claims within service expectations, industry best practices, and specific client service requirements.
Full-timeRemoteExpandApply NowActive JobUpdated 0 days ago - UpvoteDownvoteShare Job
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Specialized functions include but are not limited to the following: prescription order entry insurance adjudication troubleshooting insurance rejections filling prescriptions preparing prescriptions for final pharmacist verification delivering prescriptions to the patient bedside checking patients out through the point of sale system contacting providers with questions assisting with inventory management and restocking supplies.
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10+ years of senior experience in wholesale credit risk in an underwriting or adjudication capacity, or as a bank examiner focused on wholesale credit. Evaluate activities of lending and transaction support personnel in the Corporate Bank and Credit Risk Management, ensuring compliance with policies, approvals, monitoring and risk assessment.
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Subject to satisfactory adjudication of background investigation and/or fingerprint check. Farm Service Agency (FSA) County Employees: Permanent County employees without prior Federal tenure who are selected for a Civil Service position under Public Law 105-277 will be given a career-conditional appointment and must serve a 1-year probationary period.
Full-timeExpandApply NowActive JobUpdated 2 days ago - UpvoteDownvoteShare Job
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Evaluate solution options, Conduct impact analysis across the program (intake, adjudication, payments, correspondence, reporting, integration, portal etc) and communicate with various stakeholders (both scrum teams as well as business operation team and leadership ) regarding the actions they need to take and ensure operational readiness.
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Knowledge of claims adjudication processes, provider contracting and credentialing and member eligibility and the impact of these three functional areas working collaboratively to support successful claims processing.
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Process and perform adjudication of specialty pharmacy claims through point-of-sale functions. Serve as a technical resource pertaining to adjudication while identifying areas for improvement.
ExpandApply NowActive JobUpdated 3 days ago - UpvoteDownvoteShare Job
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Process Prescription Refills: Handle refill confirmations, review pending refills, and manage claims adjudication. Must be a Nationally Board Certified Pharmacy Technician. Process Prescription Refills: Handle refill confirmations, review pending refills, and manage claims adjudication.
Full-timeExpandApply NowActive JobUpdated 16 days ago - UpvoteDownvoteShare Job
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Fundamental understanding of claims adjudication knowledge of commercial and residential construction industries and/or basic knowledge of automotive and transportation industry desirable. The Senior Casualty/Property Liability Adjuster manages all aspects of liability claims in a variety of business classes, effectively determining and communicating the extent of liability or damage associated with each claim.
Full-timeExpandApply NowActive JobUpdated 83 days ago - UpvoteDownvoteShare Job
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Monitor changes in State and Federal laws, rules or fee schedules that impact medical bill review/re-pricing and ensure they are integrated into workflows (and Smart Advisor via Mitchell) for proper adjudication.
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Claims adjudication, Pharmacy, Data entry, Customer service, Prior authorization, Retail pharmacy, Call center, Insurance, Pharmacy technician certification, Cpht. Day to day includes census (skilled nursing facilities and making sure reports are updated) and admissions, adjudication of all claims from pharmacy, customer service, working with prior authorizations, also has skilled business so billing on that as well (Medicaid and managed care.
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Claims Adjudication Associate page is loaded. Claims Adjudication Associate. We work to distribute medical supplies, bandages, syringes, vials of flu vaccine, and pharmaceutical drugs to help real patients like Jack, an eight-year-old boy battling cancer.
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The Fraud Detection and National Security Directorate (FDNS) was established within USCIS to strengthen national security and the integrity of the country's legal immigration system by closely aligning the adjudication of immigration benefits and services with the identification of potential threats to national security and/or public safety, the detection and deterrence of fraud, and the use of law enforcement and intelligence information to ensure optimal security for U.S. communities.
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adjudication job in Raleigh, NC
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