High-Dollar Claims & DRG Integrity Specialist
Brighton Health Plan Solutions, LLC
Brighton Health Plan Solutions, LLC is seeking a High Dollar Specialist to review high dollar claims for accurate billing, pricing and adjudication, supporting the Quality Department and coordinating with internal and external stakeholders. The role requires expertise in DRGs, hospital billing, and drug reimbursement methods, with strong communication, organization, and independent work abilities. #J-18808-Ljbffr Brighton Health Plan Solutions, LLC
- ...the Role Brighton Health Plan Solutions is seeking a High Dollar Specialist to review high dollar claims for appropriate and accurate billing, pricing and adjudication... ..., units billed for drugs and procedures. Review DRG for accuracy as compared to billed procedures,...Claims
- ...High Dollar Specialist Brighton Health Plan Solutions is seeking a High Dollar Specialist to review high dollar claims for appropriate and accurate billing, pricing and adjudication. This individual... ...for drugs and procedures. Review DRG for accuracy as compared to billed...ClaimsFlexible hours
- Brighton Health Plan Solutions is seeking a High Dollar Specialist to review high-dollar claims for accurate billing, pricing, and adjudication. This role supports... ...has significant facility-based billing experience, DRG expertise, and 3-5+ years in coding and claims...Claims
- Brighton Health Plan Solutions is seeking a High Dollar Specialist to review high dollar claims for accurate billing, pricing and adjudication. This remote role... ...review pricing, pricing implants and supply charges, DRG accuracy, and related charges; develop reporting to...ClaimsRemote job
- ...Manager of Medical and Clinical Claim Policy and Configuration is a... ...determinations, and benefit integration. Leads the digitization... ...new clients and working with High Dollar team for coding, PA and benefit... ...such as CPT/HCPCS/ICD/DRG coding manuals, Specialty Society...ClaimsLocal areaRemote workFlexible hours
- Brighton Health Plan Solutions is seeking a High Dollar Specialist to review high dollar claims for accuracy in billing, pricing and adjudication. The role supports... ...of coding and claims examination experience, strong DRG knowledge, and familiarity with physician and...Claims
- ...assisted living facilities through integrated, evidence-based care. Founded... ...The Multimedia Production Specialist serves as the creative... ...Innovation & Design Studio Maintain high standards for production... ...imposters pose as recruiters claiming to represent our organization...ClaimsTemporary work
$200k
...Financial Services Reimbursement Specialist is required to successfully... ...without insurance coverage, with high deductibles and co-insurances,... ...patient per year, and 2A High Dollar Infusions. Provide an incoming... ...for clean billing and claim auditing for maximum reimbursement...ClaimsWork at officeRemote workMonday to Friday- ...education program (IEP) goals and objectives through the implementation of high-leverage strategies and best practices in teaching students with a wide range of disabilities. The EC Instructional Specialist supports the teaching staff in identifying and designing specially...Summer workWork at officeLocal area
- ...strategic analytics partner to support the Special Investigations Unit and Payment Integrity teams with actionable intelligence, dashboards, and audit support. The role combines healthcare claims expertise with advanced analysis and stakeholder engagement to drive savings...Claims
- ...technical direction of our B2B platform’s integrations with customer systems, especially ERP... ...them into technical solutions.Establish high standards for code quality, testing, and... ...uptick of fraudulent recruiting activity claiming to be associated with Higharc. All communication...ClaimsFull timeTemporary workRemote workHome officeFlexible hours
$500 per month
...excellent experience for guests? As the Deli Specialist , you willprovidedeli department... ...experience whilemaintainingoperational integrity. You willsupportdeli inventory accuracy,... ...years of age. Preferred Qualifications: High school diploma or equivalent. Retail, culinary...Seasonal workFlexible hoursAfternoon shift- Select how often (in days) to receive an alert: Infection Prevention Specialist- BSN Highly Preferred Work Arrangement: On-Site Requisition Number: 267776 Regular or Temporary: Regular Location: Durham, NC, US, 27710 Date: Aug 19, 2026 At Duke Health, we're driven...Contract workTemporary workLocal areaRelocation package
$64k - $68k
...(SHRA) Position Title Human Resources Specialist - Advanced Salary Grade Equivalent NC09... ...dedicated, innovative work processes and high-quality customer service. Benefits The... ...consultant review, while maintaining the integrity of leave records and promoting compliance...Permanent employmentFull timePart timeLive inWork at officeRemote workMonday to FridayFlexible hoursAfternoon shift- Voltage is looking for a high-energy Event Marketing Specialist to join our marketing team. Unlike traditional event roles, this position is deeply integrated into our B2B sales engine. You will be responsible for designing and executing high-impact experiences, from massive...Work experience placementH1bWork at officeLocal areaAfternoon shift
- KBI Biopharma, Inc. is seeking a Program Integration Associate II to coordinate planning, integration, and execution-readiness across process development and CMC programs. The role supports facility fit assessments, BOM forecasting, viral clearance studies, and external...
$50k - $58.9k
...Staff (SHRA) Position Title Public Comm Specialist - Journey Salary Grade Equivalent NC13 /... ...culture. We are rooted in our core values of integrity, inclusion, innovation and impact, and... ...Weekend Executive MBA Programs. This highly collaborative role serves as a primary resource...Permanent employmentFull timePart timeH1bLive inWork at officeLocal areaRemote workMonday to FridayWeekend workAfternoon shift- KBI Biopharma, Inc. is seeking a Program Integration Associate II to coordinate planning, integration, and execution-readiness across process development and CMC programs. The role applies technical and operational knowledge to support facility fit assessments, BOM forecasting...
- BIM Specialist I/II Overview Join a Team Where Engineering Excellence Drives Opportunity Affiliated... ...2 offices who plan, design, and deliver high-performance, innovative, holistic... ...and development, as well as project integration of BIM services. Expertise of our most...Work at office
- ...part of a forward-thinking, high-performing team that’s shaping... ...Security and Loss Prevention Specialist-Overnight Join Millennium Print... ...organizational security. Integrity and Respect: Conduct professional... ...401(k) Plan with up to a 6% (dollar for dollar) Employer match...Full timeTemporary workWork at officeLocal areaRelocation packageFlexible hoursNight shift
- ...Safety And Occupational Health Specialist - 40001834 This position performs difficult analytical and professional work as a member of... ...engineering controls, and hazard assessments in all work areas. Reviews claim loss runs and conducts analytical analysis of trends to...ClaimsLocal area
$18.12 - $25.51 per hour
...duties, including but not limited to, working outstanding insurance claims follow up for no response from payors, and/or claim denials.... ...Information Other information: Education Requirements: • High School Degree Licensure/Certification Requirements:...ClaimsHourly payFull time$146k - $194k
...investors and pharmaceutical, technology, and healthcare companies. For more information, please visit grail.com The Project Integration Specialist, Operational Excellence will serve as a key operational connector across laboratory, engineering, software, quality, supply...Full timeWork at officeLocal areaFlexible hours$17 - $25 per hour
...required documentation Tracks and processes claims by returning damaged goods handling... ...policies procedures and standards of ethics and integrity by implementing related action plans... ...'s Club facilities. Programs range from high school completion to bachelor's degrees,...ClaimsHourly payMinimum wageFull timeTemporary workPart time$60k
...disciplined approach built on knowledge, integrity, and lasting trust. Our Core Values... ...companies and adjusters as needed throughout the claims process. Collect payment for completed... ...conditions. What We Offer High earning potential. Average reps earn $60...ClaimsLocal areaFlexible hoursWeekend workAfternoon shift- ...Manage supplier communication, issue resolution, and return or claim processes. Identify and evaluate new suppliers to expand... ...preferred. Professional certification (CPPM or similar) preferred. High level of integrity, accountability, and attention to detail. Why Join Us? Be...ClaimsFull timeContract workH1b
$69.32k - $90k
...contractual risk requirements and assisting with claims handling and risk mitigation efforts.... ..., and demonstrate professionalism and integrity. Ability to work independently while con... ...Credentials in claims or underwriting are highly valued. PHYSICAL DEMANDS: Physical...ClaimsFull timeContract workWork at officeNight shiftWeekend work- Vitreo-Retinal Specialist/Clinician Scientist (Open Rank Faculty) Working Title: Vitreo-Retinal Specialist... ...learning within innovative and integrated curricula and team‑oriented interprofessional education to ensure a highly skilled workforce. Research: We develop and...Permanent employmentFull timePart timeFixed term contractLive inLocal area
- ...A leading insurance claims adjusting firm in Carrboro, North Carolina seeks Independent Insurance Claims Adjusters to join their team. The role offers the chance to make a meaningful impact while enjoying flexibility and competitive compensation. Candidates will be trained...ClaimsFlexible hours
- ...A national insurance claims adjustment firm is seeking Independent Insurance Claims Adjusters in Chapel Hill, NC. This opportunity is perfect for those ready to embark on a rewarding career path, helping others recover from disasters. The firm offers comprehensive training...ClaimsFlexible hours
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