Current jobs related to Director of Claims - Paoli - Alpine Solutions Group

  • Medical Claims Specialist

    1 week ago

    Paoli, United States Oral Surgery Associates Of The Main Full time

    Job SummaryWe are seeking a Medical & Dental Biller to work with our team at Oral Surgery Associates Of The Main. As a Medical & Dental Biller, you will be responsible for processing insurance claims, verifying patient information, and communicating with physicians' offices and hospitals.ResponsibilitiesProcess insurance claims through private and commercial...

  • Medical Biller Specialist

    2 weeks ago

    Paoli, Pennsylvania, United States Oral Surgery Associates Of The Main Full time

    Job SummaryWe are seeking a highly skilled Medical & Dental Biller to join our team at Oral Surgery Associates Of The Main. As a Medical & Dental Biller, you will be responsible for processing insurance claims, verifying eligibility and benefits, and maintaining accurate records. You will also assist patients with navigating the billing and insurance...

  • Medical Biller Specialist

    2 weeks ago

    Paoli, Pennsylvania, United States Oral Surgery Associates Of The Main Full time

    Job OverviewWe are seeking a highly skilled Medical Biller to join our team at Oral Surgery Associates Of The Main. As a Medical Biller, you will play a critical role in ensuring the smooth processing of insurance claims and maintaining accurate patient records.Key ResponsibilitiesProcess and verify insurance claims for both private and commercial medical...

  • Medical Biller Specialist

    1 month ago

    Paoli, United States Oral Surgery Associates Of The Main Full time

    Medical & Dental Biller Job SummaryWe are seeking a highly skilled Medical & Dental Biller to join our team at Oral Surgery Associates Of The Main. As a Medical & Dental Biller, you will play a crucial role in ensuring accurate and timely processing of insurance claims, maintaining excellent customer service skills, and working closely with patients, front...

  • Licensed Practical Nurse

    2 weeks ago

    Paoli, Pennsylvania, United States Harrison Senior Living of Chester County Full time

    Job SummaryWe are seeking a highly skilled Licensed Practical Nurse to join our team at Harrison Senior Living of Chester County. As a Licensed Practical Nurse, you will be responsible for providing high-quality resident care on a designated unit, ensuring the completion of nurse aide duties, and collaborating with all disciplines to deliver exceptional...

  • Licensed Practical Nurse

    4 days ago

    Paoli, United States Children's Hospital of Philadelphia Full time

    SHIFT: Any (United States of America) Seeking Breakthrough Makers Children's Hospital of Philadelphia (CHOP) offers countless ways to change lives. Our diverse community of more than 20,000 Breakthrough Makers will inspire you to pursue passions, develop expertise, and drive innovation. At CHOP, your experience is valued; your voice is heard; and your...

Director of Claims

2 months ago

Paoli, United States Alpine Solutions Group Full time

Our client, a fast-growing company who specializes in self-funded employe benefits firm is seeking a Director of Claims & Cost Containment. This position will work a hybrid schedule and will act as a strategic leader who is responsible for overseeing and optimizing our insurance claims management processes/cost containment strategies. This individual will be a team of one to begin with and report into the VP of Stop Loss. You will help develop innovative solutions to enhance operational efficiencies and ensure compliance with regulatory standards. The ideal candidate will possess extensive experience in insurance claims management, a strong grasp of cost containment techniques, and a proven track record of leadership in a dynamic organizational setting. Moreover, the company is currently doing the post care prepayment piece of cost containment (i.e. reducing bills that have already happened, assess billing errors, assess charges, etc). We are looking for someone who can establish process to help monitor incoming claims, negotiate the claims, over the vendor partners, and perform bill reduction strategies.

  • Claims Analysis & Review

Ensure financial accuracy of claims processing of all TPA’s

Research & apply appropriate claims processing rules & regulatory policies

Create reimbursement policies when needed

Review of benefit plans

Responsible for reporting month & quarterly findings

Complete specialized focused audits

Monitor precert and CM activity, performing precert audits pre/post appointment

Perform Quarterly Claim Audits of specific category as well as TPA claim processing audits.

  • Contract Negotiations

Interpret Provider Contracts for proper payments to ensure claims systems are paying appropriately

Negotiate with providers for when applicable

Analyze financial impact of contracts & terms

Build relationships & be the point of contact