Health Policy & Claims Integrity Lead
CVS Health
CVS Health is seeking a detail-oriented policy implementation specialist to operationalize Aetna Clinical Policy Bulletins and Payment Policies into testable coding logic for claims adjudication. The role ensures clinically sound, compliant edits with full audit traceability across lines of business. Work hours align with standard business times, and the position includes full-time hours with comprehensive benefits. #J-18808-Ljbffr CVS Health
$158.3k - $263.9k
...and affordable. Here, we focus on the health, happiness, and well-being of you... ...ahighly experienced and hands-onLead Integration/EDI Architect to lead the design, modernization, and ongoing... ...s full Equal Employment Opportunity policies, visit our Equal Employment...PolicyFull time$164.6k - $274.4k
...affordable. Here, we focus on the health, happiness, and well-being of... ...want to hear from you.Title: Lead Counsel, Digital Marketing &... ...transparency, bias, synthetic media, and claims substantiation.Advise... ...advertising and data‑use policies.Provide guidance on marketing...PolicyClaimsFull timeFixed term contractWork at officeRemote work$65k - $90k
...Member Full Time in Columbus - OH Health insurance Opportunity for... ...serving our community with integrity, care, and real support. Whether... ...helping someone navigate a claim or personalize a plan, we believe... ...compliance with established policies and procedures....PolicyClaimsFull timeWork at officeFlexible hours$65k - $90k
...Member Full Time in Columbus - OH Health insurance Opportunity for... ...serving our community with integrity, care, and real support. Whether... ...helping someone navigate a claim or personalize a plan, we believe... ...compliance with established policies and procedures....PolicyClaimsFull timeWork at officeFlexible hours$67.9k - $199.14k
...re building a world of health around every individual... ...Consulting, within the Payment Integrity Center of Excellence (... ..., will help formulate, lead, and champion strategic... ...and performance of our claim editing vendors,... ...project/program management, policy (financial analysis,...PolicyClaimsHourly payFull timeTemporary workWork experience placementLocal area$25 - $29 per hour
...from home! The Bankruptcy Team Lead will be responsible for... ...accordance with the company's policies and procedures, all US state... ...Motion for Reliefs, Proof of Claims, Transfer of Claims, Reaffirmations... ...Companies, which provide integrated, full-lifecycle mortgage loan...PolicyClaimsExtra incomeWork experience placementWork from home- ...the work of their peers in the Population Health Partnerships department related to... ...utilizing tools created by the PFK data team, claims data, Epic, and data pulled from the community... ...auto insurance as required by hospital policy and position‑specific requirements. Must...PolicyClaimsFull timeWork at officeMonday to FridayFlexible hours
- ...ICD) codes to individual patient health information for data retrieval, analysis and claims processing for the Mount Carmel... ...Culture of Safety by adhering to policy, procedures and plans that are... ...compliance with Organizational Integrity through raising questions and promptly...PolicyClaimsRemote jobWork experience placementWork at officeLocal area
$100.1k - $166.9k
...affordable. Here, we focus on the health, happiness, and well-being of you... ...You’ll Do Identity Engineering & Integrations Design, build, and maintain authentication... ..., authorization middleware, claims transformation, and access policy enforcement. Support SMART on FHIR...PolicyClaimsFull time$74.8k - $112.2k
...Behavioral Health Case Mgr - CT08IE We're determined to make... ...goes well beyond coverages and policies. Working here means having every... ...customer service and superb claim outcomes! The ideal candidate... .... Reviews clinical integration systems and determines appropriate...PolicyClaimsTemporary workWork experience placementWork at officeRemote work3 days per week$44.38 per hour
...Do At ODM Office: Data & Integrated Systems Classification: Medicaid Health Systems Administrator 2... ...serves as a technical and policy liaison for post-... ...and quality assurance. Leading bi-weekly meetings with... ...Supporting rate setting, claims remittance investigations...PolicyClaimsFull timeContract workWork at office- ...comprehensive safety programs, policies, and procedures that... ..., warehousing). Lead incident investigations... ...workers' compensation claims and ensure appropriate... ...that safety processes are integrated into daily operations.... ...degree in Occupational Health & Safety, Supply Chain,...PolicyClaimsFull timeWork at officeLocal area
- ...We are more than a health system. We are a belief system. We... ...the supported applications. Leads or participates in process... ...unit testing, volume testing, integration testing, claims parallel testing, device... ...management per departmental policy. Writes reports as directed...PolicyClaimsLocal areaRemote workShift work
$164.6k - $274.4k
...Title Lead Counsel, Digital Marketing & Ad Tech Hub Locations Atlanta... ..., bias, synthetic media, and claims substantiation. Advise stakeholders... ...advertising and data‑use policies. Provide guidance on marketing use cases involving health‑related, sensitive, or regulated...PolicyClaimsFixed term contractWork at officeRemote work$99k - $232k
...our Firm. You are expected to lead with integrity and authenticity,... ...learning techniques to large-scale claims, clinical, and member data to... ...care and improve population health outcomes for our payer clients... ...forth within the following policy: Learn more about how we...PolicyClaimsH1b- ...examines medical records and claims information for first-... ...regulations and policies. The Appeals RN works... ...Competitive paid time off ~ Health insurance, dental... ...company, is a leading not-for-profit health... ...confidentiality, and program integrity. CMS contractors and...PolicyClaimsContract workFor contractorsLocal areaImmediate startRemote work
$86.4k
...Company : Highmark Health Job Description : JOB SUMMARY... ...promotes the understanding, integration, and use of healthcare data and... ...years of working with healthcare claims data ~ Experience... ...business conduct and company policies. As a component of job responsibilities...PolicyClaimsFor contractorsWork at officeLocal area- ...business insurance, employee health & benefits, retirement,... ...of the world’s leading professional services firm... ...close the sale, deliver policies Handle complex processing and claim situations with client and... ...commitment to company values; Integrity, Collaboration, Passion,...PolicyClaimsWork at officeLocal areaNight shift
$60.3k - $145.86k
We’re building a world of health around every individual — shaping... ...Aetna Clinical Policy Bulletins (CPBs) and Aetna Payment... ...testable coding logic that drives claims adjudication across lines of... ...traceability, protecting policy integrity, claim accuracy, and enterprise...PolicyClaimsHourly payFull timeTemporary workWork at officeLocal areaMonday to Friday- ...Summary: Provides and delivers health and safety services to... ...agencies and organizational policies. Plans, implements, educates... ...reports and Workers Compensation claims/records are accurate and timely... ...Diversity, Equity and Inclusion are integrated into our core values and...PolicyClaimsWork at officeDay shiftWeekday work
- ...excellent perks! Major health benefits are available... ...strategies, programs, and policies that promote a... ...operational plans.Design and lead recurring safety engagement... ...company-wide.Oversee claims management for auto,... ...Operations Support to integrate safety data incident reports...PolicyClaimsSeasonal workWork at officeLocal areaImmediate start
- We are more than a health system. We are a belief system. We believe... ...healthcare workflows, system integration, and project management to... ...partnership with architects, tech leads and engineers. Leads process... ...with operational goals and policy. Create and maintain...PolicyClaimsWork at officeLocal areaRemote workShift work
$112k - $168k
...Mission to alleviate pain, restore health, and extend life. Our 95,000... ...Surgery Ecosystem and how to integrate it with clinical workflows... ...receive a suspicious message claiming to be from Medtronic, do not... ...compensation plansIt is the policy of Medtronic to provide equal...PolicyClaimsFull timeTraineeshipH1bWork at officeLocal areaImmediate startRemote workFlexible hours$36.01 per hour
...state of Ohio. We are currently seeking a Health Services Policy Analyst to review data quality issues... ...Extract, analyze, reconcile and integrate data from multiple sources in order to... ...accomplishments, coursework or degrees claimed on the application. Applicants will be...PolicyClaimsFull timeWork at officeLocal areaMonday to Friday$167.3k - $278.8k
...affordable. Here, we focus on the health, happiness, and well-being of... ..., and risks. You will drive integrated planning across demand,... ...as the primary relationship lead for the business, establishing... ...Equal Employment Opportunity policies, visit our Equal Employment Opportunity...PolicyFull time$44.38 per hour
...shape high-impact public health initiatives, guide... ...Bureau, you will develop policies, strengthen statewide... ...-being of Ohioans. Lead Statewide Prevention Programs... ...operations, and integration of adult hepatitis services... ...coursework or degrees claimed on the application....PolicyClaimsHourly payFull timeWork at officeLocal areaMonday to Friday- ...Responsibilities/Accountabilities Coordinates and leads the credentialing team in all physician... ...payer contract negotiations and ensures claims are adjudicated per our payer contracts.... ...and telephone, and noise in department. Policies and Procedures Knows and complies with...PolicyClaimsFull timeContract workWork experience placementDay shift
- ...AR Team Lead The AR Team Lead is responsible for the day-to-day leadership of the Accounts... ...to AR team members to ensure claims follow-up, billing, collections, payment... ...department manager in accordance with company policy. May serve as a witness during disciplinary...PolicyClaimsFull timeCasual workWork at officeLocal areaMonday to FridayShift workAfternoon shift
- ...Implements and enforces the department’s policies and procedures. Guides the department to... ...of medical terminology, various claim forms, third party contracts and payment... ...Here, Diversity, Equity and Inclusion are integrated into our core values and practices. We are...PolicyClaimsContract workFlexible hours
$26.01 - $62.32 per hour
...re building a world of health around every... ...Services strategies, policies and programs are comprised... ...and creates industry-leading solutions for our customers... ...The model is a fully integrated population health and... ...opinion requirements and claims history to address potential...PolicyClaimsHourly payFull timeTemporary workWork at officeLocal areaWork from homeMonday to FridayAfternoon shift
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