Medical Claims Specialist

Job Description The Claims Recovery Specialist is responsible for recovering incorrect claims payment to providers. Coordinates and ensures all outstanding over payments are being pursued for recovery purposes. Communicate and explain incorrect claims payments to external providers. Responsibilities Independently initiate contact with external providers in...

Job Description The Claims Auditor performs analysis and monitors trends identified through the audit process. This individual will take the lead to ensure accurate and timely adjudication of claims, as well as identifying potential issues and recommending strategies for resolution. Apply claim and/or inquiry processing experience to audit and analyze simple...

The Claims Recovery Specialist is responsible for recovering incorrect claims payment to providers. Coordinates and ensures all outstanding over payments are being pursued for recovery purposes. Communicate and explain incorrect claims payments to external providers. With approximately 9,000 physicians to serve our 260,000 members, Prospect Medical Systems...

**Claims Recovery Specialist** **CalOptima** **CalOptima Health** is seeking a highly motivated an experienced **Claims Recovery Specialist** to join our team. The Claims Recovery Specialist will be responsible for performing recoveries on claims that have been overpaid and must understand and adhere to recovery regulations mandated by CalOptima Health...

The Claims Auditor performs analysis and monitors trends identified through the audit process. This individual will take the lead to ensure accurate and timely adjudication of claims, as well as identifying potential issues and recommending strategies for resolution. Apply claim and/or inquiry processing experience to audit and analyze simple to...

Taking care of people is at the heart of everything we do, and we start by taking care of you, our valued colleague. A career at Sedgwick means experiencing our culture of caring. It means having flexibility and time for all the things that are important to you. It's an opportunity to do something meaningful, each and every day. It's having support for your...

Taking care of people is at the heart of everything we do, and we start by taking care of you, our valued colleague. A career at Sedgwick means experiencing our culture of caring. It means having flexibility and time for all the things that are important to you. It's an opportunity to do something meaningful, each and every day. It's having support for your...

About Us With approximately 9,000 physicians to serve our 260,000 members, Prospect Medical Systems is proud to be among the most innovative medical systems in California, Texas and Rhode Island. Our extensive care services range from primary care and specialty physician services to acute care hospital and skilled nursing facilities to behavioral health and...

Job DescriptionThe Eligibility Processor is responsible for uploading of eligibility files monthly, as well as updating IDX system with add, changes, and terminations, required to do research analysis on eligibility files. This person will be familiar with verifying eligibility through the health plan web sites, as well as on the telephone. Verify manual...

Job Description The Eligibility Processor is responsible for uploading of eligibility files monthly, as well as updating IDX system with add, changes, and terminations, required to do research analysis on eligibility files. This person will be familiar with verifying eligibility through the health plan web sites, as well as on the telephone. Verify manual...

Job Summary: **Responsibilities**: - Review and verify accuracy of billing and coding - Prepare and submit claims to insurance companies - Follow up on unpaid claims within standard billing cycle timeframe - Research and appeal denied claims - Post payments, adjustments, and denials to patient accounts - Maintain up-to-date knowledge of coding guidelines...

The Provider Contracting Operations Specialist will assist with maintaining all contract templates, policies and procedures, and coordinate the delivery of documentation with other business units to ensure cohesion. Assist with reviewing and delivering onboarding provider data. Work closely with the Provider Contracting department to assist with various...

The Senior Contract Configuration Specialist is responsible for creating, updating and maintaining provider dictionaries, vendor contracts, fee schedules, reading and interpreting contracts and/or contract summaries, and assigning fee schedules to providers. Responsible for creating, updating and maintaining capitation tables for capitated providers. Should...

Assistant Pathologist, under the supervision of a pathologist assists with preparing and dissecting surgical specimens. Prepares and selects tissue samples for analysis. May record findings or sterilize equipment. Weekly amount stated in the job postings is scaled based on estimated hourly wages and potential stipends available for the location of the...

Job Description Contract Pricing Analyst II - Full Time, Days (Remote) We are hospitals and affiliated medical groups, working closely together for the benefit of every person who comes to us for care. We build comprehensive networks of quality healthcare services that are designed to offer our patients highly coordinated, personalized care and help them...

The UC Irvine Department of Orthopaedic Surgery anticipates openings for a Junior Specialist position in the Department of Orthopaedic Surgery, School of Medicine, at the University of California, Irvine. We are seeking qualified individuals who are excellent in research with a strong commitment to medical education. The position will be offered in the...

Job Overview: **Duties**: - Greet and check-in patients, ensuring a positive and welcoming experience - Schedule appointments and manage the appointment calendar - Verify patient information and update medical records in electronic systems such as Epic or Eaglesoft - Answer phone calls, respond to inquiries, and provide information to patients - Collect...

Job DescriptionJob Description Alejandro Mora - State Farm Agency, located in Orange, CA has an immediate opening for a full-time Bilingual (Spanish/English) Licensed Insurance Life and Health Specialist. Must have an active Life and Health insurance license. Five years plus of Life and Health insurance sales experience is preferred. If you have experience...

Job Title: Grievance and Appeals Nurse SpecialistCalOptima Health is seeking a highly motivated an experienced TEMP - Grievance & Appeals Nurse Specialist to join our team.The Grievance and Appeals Nurse Specialist participates in managing CalOptima Healths medical appeals and state hearing reviews for all lines of business, including handling expedited and...

Job Title: Member Services RepresentativeTarget Compensation Range: $20.00-$28.00/hour, depending on the level of relevant qualifications and experience.About Us:Astiva Health, Inc., located in Orange, CA is a premier healthcare provider specializing in Medicare and HMO services. With a focus on delivering comprehensive care tailored to the needs of our...