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Key Words: Billing, Claims, Reconcile, IHS, Indian Health Services, Tribal Liaison, Medicaid, MCO, Managed Care, Tribal, Value Added, Community, Tribal 638, Tribal Governments, TCBOs, HSD/MAD, Claims Examiner, Auditor, Claims Processor.
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Compiles and organizes medical records; distributes to Medicare Compliance nurses for analysis; and provides guidance and advice on processing claims based on nurses' analysis. Analyzes lien notices for accuracy, communicates with the CMS to efficiently facilitate lien resolutions on claims and/or prepare MSA submissions in accordance with submission guidelines from CMS as assigned.
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Consideration given for Certified Fraud Examiner (CFE) credentials, but not required. Work closely with the Bank’s Operations Officer and Deposit Operations Director, as well as the Bank’s Anti-Money Laundering team, Finance, Compliance, and Technology teams, to ensure a deposit fraud prevention program is designed, stood up, and in compliance with applicable laws and regulations.
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Coordinate with counterparts in the Hermit’s Peak Calf Canyon Claims Office, Federal Emergency Management Agency, U.S. Department of Agriculture, NM Human Services Department, and other relevant agencies to coordinate programmatic solutions for clients.
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Responsible for monitoring emerging medical, pharmacy, and LTSS claims compared to forecast and revenue. Provides guidance to Controller for month close related to membership and claims impacts to emerging MER and trend.
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As a Medical Malpractice Defense Attorney, you will be responsible for defending healthcare professionals and facilities against medical malpractice claims. Responsibilities:Defend healthcare professionals and facilities against medical malpractice claims.
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One of the following areas: accounting, claims, inventory control, systems/UPC, personnel, or loss prevention/asset protection in a multi department. Manages facility-level training and execution of asset protection, safety, and claims and receiving procedures by reviewing the application of policies.
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We use best-in-class ticket and claims management systems to ensure clear and complete mark-out services for the excavator or property owner at the work site. Your Responsibilities as a Locator:Correctly, safely, and efficiently locate underground utilities, including telecommunications, electric power, cable TV, gas, water, and sewer systems.
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Ensures contract performance through risk management activities including such items as assurance of Service Level Agreement performance in Care Management Centers and Shared Services, assurance of claims accuracy payment/administrative policies, rate maximization through ongoing benefit analysis and adherence to requirements of the account's legal and regulatory environment.
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Position Overview: The Claims Examiner will act as a liaison between client, employee and healthcare provider. In our world, we help other employers manage their Disability Claims when an employee gets sick, injured, has a baby, needs a surgery, or something similar that will require them to be out of work for a while.
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Provide industry expertise in cost management systems & project controls, including budgeting, documenting physical progress, documenting actuals, documenting commitments, contract management including managing changes and variations, payment applications and claims, measuring performance, supply chain management, calculating earned value, and analyzing reports.
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Investigate and prepare required reports of EHS system performance including but not limited to investigation reports, injury reports, insurance claims, performance metric reports, etc. Bachelor's Degree in Engineering, Industrial Hygiene or Social Science related field.
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This position is responsible for the administration of taxpayer accounts as part of Personal Income Tax by effectively working with internal and external customers to achieve desired work results and maintains positive relationships while achieving consistency, thoroughness and accuracy on assigned work and projects.
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Required Qualifications: 2 years of experience in automated, computerized account follow-up system in a hospital setting, health insurance claims processing or medical office. Required Qualifications: 2 years of experience in automated, computerized account follow-up system in a hospital setting, health insurance claims processing or medical office.
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Maintains the Sales Floor and merchandise presentation in the Freezer/Cooler/Deli area in accordance with Company policies and procedures by properly handling claims and returns; zoning the area; receiving and stocking merchandise; setting up, cleaning, and organizing product displays; removing damaged goods; signing and pricing merchandise appropriately; completing required audits, paperwork, logs, and other required documentation; and securing fragile and high-shrink merchandise.
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examiner claims jobs in Santa Fe, NM
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