Specialist, Claims

**JOB DESCRIPTION** **Job Summary** Responsible for reviewing Medicaid, Medicare, and Marketplace claims for overpayments; researching claim payment guidelines, billing guidelines, audit results, and federal regulations to determine overpayment accuracy and provider compliance. Interacts with health plans and vendors regarding recovery outstanding...

Job Description: Position is fully remote and will be a temp role through 3/31/23. Position has the option to go perm based on positive work. Candidates can sit anywhere in the US and schedule will be M-F 9AM-5PM local time. The training schedule will be M-F 9AM-5PM EST. Daily responsibilities will include the following: Candidates will be reviewing medical...

Job DescriptionJOB DESCRIPTIONJob Summary Utilizing clinical knowledge and experience, responsible for review of documentation to ensure medical necessity and appropriate level of care utilizing MCG/InterQual, state/federal guidelines, billing and coding regulations, and Molina policies; validates the medical record and claim submitted support correct coding...

Job Summary Responsible for reviewing and resolving member and provider complaints and communicating resolution to members and provider (or authorized representatives) in accordance with the standards and requirements established by the Centers for Medicare and Medicaid KNOWLEDGE/SKILLS/ABILITIES Responsible for the comprehensive research and resolution...

**Remote and must live in Wisconsin** Job Summary Provider Network Administration is responsible for the accurate and timely validation and maintenance of critical provider information on all claims and provider databases. Staff ensure adherence to business and system requirements of internal customers as it pertains to other provider network management...

Job DescriptionJOB DESCRIPTIONJob Summary Responsible for reviewing and resolving member and provider complaints and communicating resolution to members and provider (or authorized representatives) in accordance with the standards and requirements established by the Centers for Medicare and Medicaid KNOWLEDGE/SKILLS/ABILITIES Responsible for the...

Job Summary Provider Network Administration is responsible for the accurate and timely validation and maintenance of critical provider information on all claims and provider databases. Staff ensure adherence to business and system requirements of internal customers as it pertains to other provider network management areas, such as provider...

Job DescriptionJob DescriptionHungry for an opportunity to leverage your experience and skills in a mission driven health care organization? Do you have the humility and communication skills to provide excellent service to the Butterfly Effects families across the country?BUTTERFLY EFFECTS, LLC a nationwide ABA informed Therapy Provider is looking for...

Job DescriptionJob DescriptionYou will contribute to the strength of our team approach to collaborative dental health.Do you value making an impact and doing meaningful work? Are you ready to be a difference-maker at an established independent Employee-Owned specialized healthcare company? If you enjoy working with a team of caring and dedicated people, this...

Job DescriptionJob DescriptionYou will contribute to the strength of our team approach to collaborative dental health.Do you value making an impact and doing meaningful work? Are you ready to be a difference-maker at an established independent Employee-Owned specialized healthcare company? If you enjoy working with a team of caring and dedicated people, this...

Job DescriptionJob DescriptionThe billing specialist is responsible for obtaining and following up on payments from patients and insurances based on established contracts.ResponsibilitiesReview and process account adjustments and overpayment refunds in an efficient and timely mannerRespond to detailed questions from patients and payers regarding claims or...

Job DescriptionJob DescriptionThe billing specialist is responsible for obtaining and following up on payments from patients and insurances based on established contracts.ResponsibilitiesReview and process account adjustments and overpayment refunds in an efficient and timely mannerRespond to detailed questions from patients and payers regarding claims or...

INTAKE SPECIALIST WITH PERSONAL INJURY EXP NEEDED SHIFTS AVAILIBLE: 9AM-6PM AND 10AM-7PM Kogan & DiSalvo serves primarily Palm Beach, Martin, Broward, St. Lucie, and other surrounding counties. If you are looking for an excellent personal injury firm with an incredible reputation and high-integrity leaders, then this might be EXACTLY what you are looking...

Overview Guides client through the unemployment hearing process and serves as a client representative. Responsibilities Prepares clients for unemployment hearings to ensure that the client is knowledgeable on the process and that all appropriate information has been gathered. Serves as client representative in unemployment hearings to ensure that the client...

Millennium information Services, Inc. is a leader in the insurance outsourcing arena.  We provide high quality inspections and process solutions to the property and casualty industry.  We have a short-term full-time opening for a Field Reporting Specialist in the Kansas City area. This position is limited to 6-months with potential for contract extension,...

Job DescriptionJob DescriptionFHEHealth (“FHE”) is a dually accredited (CARF and JOINT) licensed behavioral healthcare institution that delivers quality, medically integrated personalized treatment for First Responders suffering from Behavioral Health Disorders. We specialize in addictive disorders, and other behavioral health diagnoses such as mood...

 FHEHealth (“FHE”) is a dually accredited (CARF and JOINT) licensed behavioral healthcare institution that delivers quality, medically integrated personalized treatment for First Responders suffering from Behavioral Health Disorders. We specialize in addictive disorders, and other behavioral health diagnoses such as mood disorders, depression, anxiety,...

Job DescriptionJob DescriptionTTF is looking for a Prior Authorization/Verification Biller to work for a client in Newport Beach, CA. The starting salary will depend on experience and our client offers a pleasant work environment.Job duties include: Verify insurance information for upcoming procedures, obtain pre-authorization for procedures, explain to...

Overview: Guides client through the unemployment hearing process and serves as a client representative. Responsibilities: Prepares clients for unemployment hearings to ensure that the client is knowledgeable on the process and that all appropriate information has been gathered. Serves as client representative in unemployment hearings to ensure that the...

Job DescriptionJob DescriptionHR SpecialistSummary:Reporting to the VP of Finance, the Human Resources Specialist will serve as the key HR point of contact for our 100+ employees in the US regarding payroll, benefits and other HR matters. The Human Resources Specialist can expect to handle a wide range of HR tasks including but not limited to: facilitating...