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LOCATION: Remote
GENERAL STATEMENT OF JOB
Responsible for all accounting functions related to a designated area of physical and behavioral health medical claims processing to ensure that providers receive timely and accurate payment. This position is responsible for claims adjudication through continuous monitoring and quality control measures. Responsibilities include finalizing c...

At MultiPlan, we pride ourselves on being a dynamic team of innovative professionals. Our purpose is simple - we strive to bend the cost curve in healthcare for all. Our dedication to service excellence extends to all of our stakeholders -- internal and external - driving us to consistently exceed expectations. We are intentionally bold, we foster innovation, we nurture accountability, we champ...

The Medical Only Claims Specialist manages non-complex and non-problematic, medical only claims and minor lost-time workers' compensation claims under close supervision, supporting the goals of claims department and of CorVel.
This is a hybrid position.
ESSENTIAL FUNCTIONS & RESPONSIBILITIES:
* Receives claims, confirms policy coverage and acknowledgement of the claim
* Determines the v...

APPEALS SPECIALIST
POSITION SUMMARY
The Appeals Specialist will be responsible for the organization and completion of all claim appeals received in the Appeal Department.
ESSENTIAL FUNCTIONS
* Logging/tracking all appeals received
* Reviewing appeal and supporting documentation
* Reviewing Summary Plan Documents to determine validity of appeal
* Composing appeal response le...

LOCATION: Remote – This is a home based, virtual position that operates Monday-Friday from 8:30am-5:00pm EST. Vaya Health welcomes applications from NC, SC, GA, TN, VA, MD, and FL.
GENERAL STATEMENT OF JOB
Responsible for all accounting functions related to a designated area of physical and behavioral health medical claims processing to ensure that providers receive timely and accurat...

Overview
Under the general direction of Business Operations Manager or designee, the Medical Claims Examiner is responsible for processing professional and facility medical services claims by reviewing and inputting data into the claims payment system using standard policies, procedures and guidelines. This position will also be responsible for invoice adjudication/payments with contract terms...

Job Summary:
The Medical Claims Research Specialist supports the HEDIS (Healthcare Effectiveness Data and Information Set) reporting period by reviewing medical claims, identifying appropriate medical records and providers, and documenting follow-up actions. This role operates under the direction of Quality Program Managers, ensuring timely and accurate data collection.
Key Responsibilities:...

Become a part of our caring community and help us put health first
The Medical Director actively uses their medical background, experience, and judgement to make determinations whether requested services, requested level of care, and/or requested site of service should be authorized at the Inpatient level. All work occurs within a context of regulatory compliance, and work is assisted by div...

Company Description
WHO IS GUIDEHEALTH?
Guidehealth is a data-powered, performance-driven healthcare company dedicated to operational excellence. Our goal is to make great healthcare affordable, improve the health of patients, and restore the fulfillment of practicing medicine for providers. Driven by empathy and powered by AI and predictive analytics, Guidehealth leverages remotely-embedded H...

Summary of Job
Support contract performance management of a large health system. Review and analyze suspected underpaid and overpaid claims from hospital, ancillary, and provider groups based on contractual and industry guidelines. Identify and analyze single issues and trends to determine root causes.
Provide recommendations for solutions to minimize errors and delays in systems and/or process...

Overview
We have an exciting Medical Professional Claims Analyst career opportunity for an experienced professional to join our team at Pediatrix Medical Group. We are a physician led organization, and one of the nation's largest providers of prenatal, neonatal and pediatric services.
Talented business professionals from diverse backgrounds choose Pediatrix because we are an exciting and innova...

Job Details
Level: Experienced Job Location: Sacramento - Rancho Cordova, CA Position Type: Full Time Education Level: High School Diploma or GED Salary Range: $65,000.00 - $75,000.00 Salary/year Travel Percentage: None Job Shift: Day Job Category: Insurance
Claims Examiner I _ Medical Only
POSITION SUMMARY: At the direction of the Claims Supervisor (or designate...

An exciting opportunity exists to join the ProAssurance family of companies!
Our mission is powerful and simple: We protect others. Choosing a place to apply your talents is an important decision for anyone. You have plenty of options. Why choose ProAssurance?
At ProAssurance, we sell a pledge, and that pledge is delivered by our team members. We are seeking individuals who value integrity, l...

The range for this role is $99,000 - $142,000
Actual base pay will be determined based on a successful candidate's work location, skills/abilities, experience, and education. This role includes opportunity to receive an annual bonus target of 10% of annual eligible earnings. Actual bonus amounts are determined by length of time in role, individual performance, and organizational performance.
In...

Overview
Empower AI is AI for government. Empower AI gives federal agency leaders the tools to elevate the potential of their workforce with a direct path for meaningful transformation. Headquartered in Reston, Va., Empower AI leverages three decades of experience solving complex challenges in Health, Defense, and Civilian missions. Our proven Empower AI Platform® provides a practical, sustain...

Employment Type:
Full timeShift:
Description:
POSITION PURPOSE
Work Remote Position
(Pay Range: $16.1738-$24.1614)
Performs day-to-day payment posting reconciliation activities within the hospital revenue operations ($3-5B NPR) of an assigned Patient Business Services (PBS) location. Serves as a member of the Payment Posting team at an assigned PBS location responsible for ensuring accurate ...

Description
Part of the Western Growers Family of Companies, Western Growers Assurance Trust (WGAT) was founded in 1957 to provide a solution to a need in the agricultural community - a need for employer-sponsored health benefit plans not previously available from commercial health insurance carriers. WGAT is now the largest provider of health benefits for the agriculture industry. The sponsori...