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Working knowledge of claims processing, correspondence and CRM platforms and adjudication strategies Demonstrated Experience with claims testing/auditing/QA Extensive knowledge of health care provider audit methods and provider payment methods, clinical aspects of patient care, medical terminology, and medical record/billing documentation Proven ability to apply quantitative and/or qualitative research and data analysis techniques to improve operational processes.
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PRIMARY PURPOSE OF THE ROLE: To analyze high-level Workers Compensation 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.
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The Claims Supervisor is responsible for the daily oversight of claims processes including but not limited to the inquiry and resolution process, adjudication process, user acceptance testing and quality assurance, training, and reporting.
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Candidate must demonstrate the ability to understand and navigate the payer adjudication process. The Customer Service Specialist II must exhibit professional and courteous behavior at all times during patient and/or client interaction.
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Duties Description The Administrative Law Judge, under the title of Motor Vehicle Referee, will be engaged in professional legal work conducting administrative hearings and rendering decisions for the adjudication of moving traffic violations, as well as those involving fatal accidents, persistent violators, false statements on Motor Vehicle documents, or driving without insurance.
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Provide effective risk assessment, credit analysis, adjudication and monitoring of an Asset Backed Securities (ABS) portfolio. 3+ years experience with Securitization or Structured Products Post-graduate degree in a quantitative area such as mathematics, finance, engineering preferred Previous credit risk, market risk, or rating agency experience preferred Proficiency with Word, Excel, PowerPoint High level of self-motivation; able to manage conflicting priorities Able to work independently; able to work well in teams What’s in it for you.
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Working knowledge of Claims Processing, correspondence and CRM platforms and adjudication strategies. Working knowledge of Claims Processing, correspondence and CRM platforms and adjudication strategies.
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3+ years of either Inpatient Claim Billing or Inpatient Claim Adjudication Experience. As such, we are a leading authority in payment integrity solutions including DRG Validation, Cost Outlier and Readmission reviews.
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Healthcare Business Analyst (MUST HAve - Health Insurance, Payer, EDI, Enrollment Claim & Adjudication) Healthcare Business Analyst (MUST HAve - Health Insurance, Payer, EDI, Enrollment Claim & Adjudication.
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Providing support for the processing of forms and applications used in the adjudication process, The File Clerk is a permanent, full-time position supporting the overall mission of the U.S. Citizenship and Immigration Services (USCIS) by facilitating the operations of a local Field Office.
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As a wholly-owned subsidiary of NYC Health + Hospitals, the largest public health system in the United States, MetroPlus Health 's network includes over 27,000 primary care providers, specialists and participating clinics.
$70,000 a yearFull-timeExpandApply NowActive JobUpdated 2 days ago - UpvoteDownvoteShare Job
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Strong knowledge of group benefit plans, claims adjudication, medical terminology, and claims codes (ICD-10, CPT, HCPCS). You will supervise and manage claims operations, including evaluation, adjudication, auditing, reports, appeals, and customer service, while ensuring compliance with company policies and regulations.
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Identifies edits to adjudication system that are not working properly or need to be installed so claims can be processed. Researches and maintains knowledge in coding and billing guidelines and trends.
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The Insurance Verification Specialist I is responsible for verifying health insurance benefits for all new patients or existing patients. Patient financial and practice management system experience in Epic and or other of electronic billing systems is preferred.
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Ability to obtain and maintain favorable adjudication of a Top Secret security clearance. Thorough understanding of federal investigative standards, including the investigative tiers, issue resolution and adjudication.
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adjudication job in New York, NY
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