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As the FRM North Texas your duties will include but is not limited to Prior Authorization assistance, Claims Assistance, and Appeals and educating the office on Payer landscape. Reimbursement Support on Case management, billing and coding updates, appropriate claims submission, Specialty Pharmacy, Medical Benefit Interpretation, understanding medical necessity, claims and appeal assistance, information related to co-pay assistance and patient assistance programs.
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MetroPlus Health provides the highest quality healthcare services to residents of Bronx, Brooklyn, Manhattan, Queens and Staten Island through a comprehensive list of products, including, but not limited to, New York State Medicaid Managed Care, Medicare, Child Health Plus, Exchange, Partnership in Care, MetroPlus Gold, Essential Plan, etc.
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Partner with and collaborate across functions on analytics and strategic initiatives, including, but not limited to, Underwriting, Actuarial, Reinsurance, Claims, and Operations. Experience with and exposure to various operational disciplines (underwriting, claims, IT, etc.
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2+ years of experience within hospital billing/claims processing, revenue cycle operations, revenue metrics and analytics, and revenue management or consulting experience. NYC Health + Hospitals is the largest public health care system in the United States.
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Manage and lead the revenue cycle management team and processes, including benefits verification, claims submission, payment posting, denials management, and revenue optimization. You will be responsible for managing and optimizing the end-to-end revenue cycle operations, including benefits verification, claims submission, payment posting, denials management, and revenue optimization.
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Job Description Field Investigator Job Classification: Non-Exempt Position Summary: A majority of the work activity involves field SIU requiring the investigator to obtain high quality videotape documentation of claimants who have filed workers compensation and liability/personal injury claims.
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Building robust integrations with large enterprise clients, such as EMR integrations with healthcare providers, claims data structuring with health plans, and HIE records parsing. Proficient with our tech stack: React (Typescript), NextJs, React Native, Postgres (Supabase), HTML/CSS (Tailwind), AWS Infrastructure.
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You will be helping our clients and their counsel understand and resolve the financial impacts around their legal matters relating to complex accounting and financial issues across a wide range of projects involving economic disputes, claims, misunderstandings, investigations of white-collar crime, forensic accounting and consulting, and post-acquisition disputes often for companies in bankruptcy or in distress.
$100,000 - $140,000 a yearFull-timeExpandApply NowActive JobUpdated 4 months ago - UpvoteDownvoteShare Job
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Estimating knowledge using CoreLogic and/or Xactimate is required, along with the ability to navigate within Corelogic suites and guidewire claims handling platforms. Collaborates and consults with our Inland Marine/Builders Risk Underwriting and Engineering partners to determine liability and identify risk conditions to drive continuous improvement toward claims handling and risk management excellence.
$91,800 - $192,700 a yearFull-timeExpandApply NowActive JobUpdated Today - UpvoteDownvoteShare Job
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Conduct a thorough investigation of all claims and retain outside surveyors, adjusters, experts, defense counsel, coverage counsel, as needed, based on the severity of the claim, and the facts presented.
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We are carrying out due diligence to acquire a large tenure of claims that have the potential to host a large porphyry base and precious metals system with demonstrated potential for significant metal endowment at economic grades.
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Builds alliances with other departments responsible for functional aspects of the BH/HARP including but not limited to Quality Management, Utilization Management, Case Management, Sales, Eligibility, Core System Operations, Provider Network Operations, Member Services/Experience Services, Claims, Analytics & Reporting, and Finance to ensure collaboration, efficiency, issue resolution and operational excellence.
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Analyze and interpret complex data sets from multiple sources (claims, EMR, billing) to identify trends and insights that drive value-based care strategies. The ideal candidate will have a strong understanding in one of the following areas: ACOs, shared savings settlements, Medicare pricing, and or experience working with claims data.
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Gallagher Bassett is the premier provider of global claims, loss control, and risk management consulting services, dedicated to exceptional customer service and demonstrably superior outcomes. Gallagher Bassett Technical Services is seeking a qualified environmental, health, and safety (EHS) professional to become a valued member of our Industrial Hygiene/Safety & Building Sciences team.
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Identifies Medicaid eligibility issues and works closely with appropriate departmental staff, Local Department of Social Services (LDSS)/Human Resources Administration (HRA) and Third Party Administrator (TPA) in resolutions.
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claims tpa jobs Company: Metroplus Health Plan in Jersey City, NJ
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