Medical Claims Processor

Job DescriptionCompany OverviewAdvanced Medical Manage is a leading healthcare management company seeking an experienced Healthcare Claims Processing Lead to join our team.Estimated Salary:$80,000 - $110,000 per yearJob SummaryWe are looking for a skilled and detail-oriented Healthcare Claims Processing Lead to oversee the claims processing workflow and...

Job OverviewThe Medical Claims Review Specialist will be responsible for reviewing facility claims to ensure compliance with medical necessity and billing standards. This role involves conducting retrospective utilization reviews, preparing cases for medical director oversight, and ensuring adherence to regulatory and accreditation requirements.Key...

About SedgwickSedgwick is a leading global provider of technology-enabled risk, benefits and integrated business solutions. Our purpose is to take care of people, and we strive to make a positive impact on the world through the people and organizations we serve.Job DescriptionWe are seeking a skilled Compensation Claims Adjudicator to join our team. As a...

Job SummaryWe are seeking a Claims Resolution Specialist to join our team at TAJ Technologies Inc. This role is responsible for analyzing and resolving workers' compensation claims, ensuring compliance with company standards and industry best practices.About the RoleThis position involves managing workers' compensation claims from start to finish,...

At Sedgwick, we believe in the value of caring for our colleagues and clients alike. Our mission is to provide exceptional service and support to those who need it most.What We Offer:We offer a comprehensive benefits package that includes medical, dental, vision, 401k and matching, PTO, disability and life insurance, employee assistance, flexible spending or...

About SedgwickSedgwick is a leading global provider of technology-enabled risk, benefits and integrated business solutions. Our mission is to help our clients protect their brand, minimize business interruptions, and provide exceptional customer experiences. Job Description: Claims Team Lead - Workers CompensationPrimary Responsibilities:Supervise multiple...

Job SummaryWe are seeking a highly skilled and detail-oriented Medical Billing & Back Office Specialist to join our team at Vensure Employer Services. This individual will be responsible for processing medical claims, collecting patient or provider payments, resolving questions and problems with customer accounts, and performing various administrative...

Job OverviewThe Contract Configuration Analyst I role at Advanced Medical Manage is a key position that requires strong analytical and problem-solving skills to support the configuration of our system. This role is responsible for ensuring accurate payments of claims and capitations to providers, vendors, and other stakeholders.Key Responsibilities:We are...

We are seeking a skilled Medical Billing Specialist to join our team at JOSEPH VARDAYO MD INC in Long Beach. This role requires strong attention to detail, excellent customer service skills, and the ability to work closely with clients and medical professionals.Job DescriptionThis position involves processing insurance claims through private insurance and...

About the RoleAre you a detail-oriented healthcare professional with a passion for delivering high-quality care? Blue Shield of California is seeking a skilled Clinical Coding Analyst RN, Senior to join our team. As a member of our Facility Compliance Review team, you will play a critical role in ensuring the accuracy and integrity of medical coding for our...

**Job Summary:** Insurance Claims CoordinatorAbout the Role:We are seeking a highly organized and detail-oriented Insurance Claims Coordinator to join our team at Colorado Center For Reproductive Medicine. As a key member of our billing department, you will be responsible for processing insurance claims, following up on outstanding balances, and maintaining...

About the RoleWe are seeking a highly skilled and experienced System Configuration Lead to join our Clinical Operations team at Advanced Medical Management.Job SummaryThe successful candidate will be responsible for managing and overseeing system configuration, benefits, and provider data to ensure accurate reflection of provider contracts and claims...

Job SummaryWe are seeking a highly organized and detail-oriented Medical Benefits Administrator to join our team at Advanced Medical Manage.The ideal candidate will have experience with benefits configuration and interpretation, as well as excellent analytical and problem-solving skills. The selected individual will be responsible for supporting all aspects...

At Advanced Medical Manage, we are seeking a highly skilled Director of Health Data Operations to oversee the management of electronic data interchange (EDI) systems, eligibility verification, and capitation processes.Job SummaryThe successful candidate will be responsible for ensuring the accurate transmission of claims, capitation, eligibility...

Medical Billing PositionWe are seeking a Medical Billing Professional to join our team at JOSEPH VARDAYO MD INC in Long Beach. As a key member of our staff, you will be responsible for working closely with clients to answer questions related to billing, processing all forms needed for insurance billing purposes, and collecting necessary documentation from...

Job OverviewAt Advanced Medical Manage, we are seeking an EDI Process Specialist to join our team. This is a unique opportunity to work in a fast-paced environment and make a significant impact on the organization's operations.Salary: $80,000 - $110,000 per yearAbout the RoleThe EDI Process Specialist will be responsible for managing and overseeing...

At Blue Shield of California, we're seeking a highly skilled Healthcare Compliance Specialist to join our Facility Compliance Review team. As a key member of this team, you will play a vital role in reviewing post-service prepayment facility claims for contract compliance, industry billing standards, medical necessity, and hospital-acquired conditions/never...

Senior Healthcare Compliance Specialist Job DescriptionIn this challenging role, you will be responsible for conducting retrospective utilization reviews to ensure compliance with medical necessity and billing standards.The ideal candidate will possess strong analytical skills and effective communication to manage claims and improve quality of care. You will...

Job SummaryThe Clinical Review Specialist, Senior at Blue Shield of California will lead retrospective utilization reviews and first-level determination approvals for members using BSC evidenced-based guidelines, policies, and nationally recognized clinical criteria across lines of business or for a specific line of business such as Medicare and FEP.Key...

Role Overview:The Clinical Coding Analyst RN Senior will be responsible for performing in-depth quality audits of hospital claims to support ICD-10-CM and ICD-10 PCS codes, as well as MS-DRG and APR-DRG reviews based on clinical determination. This role requires a strong understanding of medical necessity and reimbursement requirements, as well as the...