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As an Auto Claims Examiner, you will be responsible for accurately assessing and processing auto insurance claims. - Review and analyze auto insurance claims to determine coverage, liability, and the extent of damage.
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Demonstrated knowledge of SAP/OPUS, claims, supply chains, Customs & Border Patrol (CBP) and compliance/FMC/PGA s. · Evaluate and process insurance claims if required. Demonstrated knowledge of SAP/OPUS, claims, supply chains, Customs & Border Patrol (CBP) and compliance/FMC/PGA s.
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Support patient access assistance from prescriber decision through to fulfillment, supporting the entire Reimbursement journey through payer prior authorization to appeals/denials requirements procedures and forms.
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Ability to proficiently read and interpret medical records, claims data, pharmacy, lab reports and prescriptions required. 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.
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The Finance Office is requesting to hire an Administrative Staff Analyst NM-I to function as a Quality Assurance Manager within the Revenue & Reimbursement Office to handle the increased volume of claims due to COVID-19 and Asylum seekers and the frequency of audit reviews issued from Federal & State entities, single audits, and OMB with shorter deadlines for compliance.
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Analyze population health and performance improvement metrics, analyze payer claims data to monitor quality performance such as HEDIS metrics. In addition, responsibilities include analyzing population health and performance improvement metrics, synthesizing and analyzing payer claims data feeds to monitor quality performance such as HEDIS metrics.
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Arlo’s founding team has extensive experience in claims analytics, data science, benefits administration systems, and health plan underwriting. Experience working with medical and prescription drug claims data.
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Try and/or arbitrate cases and prepares motions in liminie and summary documents Draft post-trial motions Prepare for and participate in appeals Provide legal opinions to claims clients Investigate and pursue subrogation litigation as appropriate Second chair cases with Trial Attorneys and Senior Trial Attorneys as needed.
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Manage department's multi-faceted fundraising workflow (events, annual appeal, recurring appeals, corporate partnerships, grants, etc.) The ideal Database Specialist will create a positive workplace culture, fostering employee development, and ensuring that employees are equipped with the skills needed to contribute effectively to FCA's success.
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The Office's professional staff perform a variety of key functions, including supporting the Trial, Investigation, and Appeals Divisions, as well as other prosecution support and office functions.
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AXIS is seeking a TPA & Programs Claims Shared Services Lead to join our TPA, Litigation and Vendor Management Services North America Claims team. As a direct report to the Head of Axis claims TPA, Litigation & Vendor Management, Claims Shared Services, the successful candidate should possess the ability to develop and execute a TPA & Program claim service model for Axis North America TPA & Programs Claims.
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Medicare Part D subject matter expertise in coverage determination and appeals reviews and audits. The Enterprise Solution team seeks individuals who are passionate to change the landscape of claims processing while providing superior service.
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Experience preparing appeals for DRG Denials. Formulates timely written appeal responses to Third Party Payors, RAC, and all other DRG payment denials based on expertise in Clinical Validation and Coding practices as outlined by AHIMA, AHA, coding Clinic, the AMA, CMS, UHDDS Data Element Definitions, and Evidence-based Practice Literature.
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Assists with the coordination and testing of system updates prior to live implementation, coordinates and responds to internal and external audits requests relative to accounts receivable, processes claims through clearing house platform(s) to determine completeness of billing and correct missing charges, refiles cases in 3M coding system for APC / APG calculation as needed, and performs other receivables assigned duties.
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Leverage consumer insights, ratings and reviews, & market opportunities to drive formula & claims optimization. Identify opportunities for continuous optimization of amika’s core revenue drivers to improve performance, stability, market value, claims, and innovation.
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claims appeals jobs Company: Metroplus Health Plan in Springfield Gardens, NY
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