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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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The Provider Reimbursement Admin ensures accurate adjudication of claims, by translating medical policies, reimbursement policies, and clinical editing policies into effective and accurate reimbursement criteria.
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Healthcare industry experience as it relates to risk adjustment, medical claims submissions, adjudication and payment, eligibility, encounters file management in particular for Medicaid/Medicare populations.
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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.
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Coordinates plan design review and strategies with other UMR departments, provides financial analysis, and recommends modifications to existing benefit plan(s) to enhance or streamline coverage to meet the customer’s needs or industry trends or to increase customer’s auto adjudication rates.
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Working & Team handling Experience in claim adjudication/ Payment integrity/Enrollment. Working & Team handling Experience in claim adjudication/ Payment integrity/Enrollment. Advanced knowledge of MS Word, MS Excel and Data management.
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May resolve issues of denials identified through adjudication, and follow-up claims in Point of Sale (POS) PharMerica is the long-term care pharmacy services provider of choice for senior living communities, skilled nursing facilities, public health organizations and post-acute care organizations.
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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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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.
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