Rx Claims Expert: PBM & Adjudication Specialist
Saransh Inc
Saransh Inc is seeking an Rx Claims SME based in Eden Prairie, MN. The role involves deep knowledge of PBM concepts and claims processing. Candidates should have over 10 years of experience in the industry and the ability to facilitate discussions with stakeholders effectively. This hybrid position allows for flexibility while requiring expertise in drug pricing and utilization review. A strong focus on root cause analysis and data management is essential. #J-18808-Ljbffr Saransh Inc
- ...Prairie, Minnesota, is seeking a skilled professional with in-depth knowledge on RxClaim Adjudication and claims processing. The ideal candidate will have a strong understanding of PBM concepts, including drug pricing and copays, and be proficient in managing data...Claims
- Role: Rx Claims SME Location: Eden Prairie - MN; hybrid W2 Position Name Benefit Administration-PBM Pharmacy Claims JD: In depth knowledge on RxClaim Adjudication, claims processing, MedD claims Deep knowledge of PBM concepts, including drug pricing, copays, accumulators...Claims
$24 - $43 per hour
...is seeking a Senior Medical Coder to ensure accurate medical coding for reimbursement and support functions within charge review and claim edits. This role is pivotal in maintaining coding accuracy and supporting the revenue cycle. The ideal candidate will have a minimum...ClaimsHourly payRemote work- ...a Remote Subrogation Agent to join their expanding team. The successful candidate will conduct calls to resolve outstanding damage claims while ensuring compliance with regulations. Candidates should have 1-3 years of relevant experience and excellent communication skills...ClaimsRemote work
$17 - $18.15 per hour
...and holidays We are searching for the next Patient Access Specialist champion. This role is responsible for performing admitting duties... ...Collections) and billing processes to assist with a clean claim rate. Responsible for accurately screening of medical necessity...ClaimsFull timeWork at officeShift workNight shiftAfternoon shift$23 - $25 per hour
...Minneapolis Radiation Oncology has an opening for a Prior Authorization Specialist position at our Business Office in Minneapolis (near the Edina... ...radiation treatments or procedures to ensure health insurance claims are processed and paid correctly · Communicate internally...ClaimsHourly payFull timeWork at officeRemote workMonday to FridayFlexible hoursShift work2 days per week1 day per week- ...Full-time onsite for approximately 23 weeks (depending on candidate) Responsibilities: Manage and follow up on billed and unpaid DME claims for Commercial, Medicare, Medicaid, and private pay accounts. Perform insurance claim follow-up via payer portals and telephone....ClaimsFull timeContract workTemporary workFlexible hours
- Acosta Sales & Marketing is seeking a Food Demonstrator in Shakopee, Minnesota. This role involves preparing juice and specialty products, conducting product demonstrations, and ensuring compliance with food safety standards. Ideal candidates have experience in the food...
- ...Senior Claims Examiner Driasi is an ambitious, innovative and fast-paced company. We offer exceptional training and development programs... ...Insurance Carriers or other professionals to best determine adjudication of a claim. Assists in carrier audits and monthly audits for...ClaimsTemporary workWork at office
- ...Job Title: Reimbursement Specialist This will by a hybrid role - 2 days required onsite... ...timely collecting of billed and unpaid DME claims related to Commercial, Federal, and... ...assignments. Serve as a subject matter expert in the absence of the supervisor. Collaborate...ClaimsContract workTemporary workFlexible hours
- ...of absence programs, ensuring compliance and effective communication across HR and related vendors. The ideal candidate will manage claims from initiation through resolution while providing operational support to employees and managers. Strong organizational skills and...Claims
$23 - $27 per hour
...member of the Revenue Cycle Department and reports to the Director, Contract and Revenue Cycle. The Revenue Cycle Specialist will help facilitate claims, payments, and verifications daily. The Revenue Cycle Specialist will provide updates and reports on the financial...ClaimsContract workWork at officeLocal areaWork from homeFlexible hours- ...A leading claims adjusting firm is seeking Independent Insurance Claims Adjusters in Minnetonka, MN. The role involves helping clients recover from disasters while providing flexibility and competitive compensation. Candidates can be experienced or new and will receive...Claims
- ...reimbursements while telecommuting from anywhere in the U.S. In this role, you'll use your ICD-10 coding expertise to audit inpatient claims, identify overpayments, and support your findings with written rationales. The position offers competitive base pay, a...ClaimsRemote job
- ...Senior Therapeutic/Prevention Specialist At Gilead, we're creating a healthier world for all people. For more than 35 years, we've tackled... ...regulations, the Federal Anti-Kickback Statute, the False Claims Act, PhRMA, Corporate Code of Business Conduct and the Office of...ClaimsWork at officeLocal areaWorldwide
$133.2k - $172.37k
...threatening illnesses worldwide. As a Senior Therapeutic/Prevention Specialist within Gilead's – Minneapolis, MN, you will represent Gilead's... ...regulations, the Federal Anti-Kickback Statute, the False Claims Act, PhRMA, Corporate Code of Business Conduct and the Office of...ClaimsFor contractorsWork at officeLocal areaWorldwide- ...Job Posting The Medicare Specialist is responsible for ensuring Medicare criteria is met for claim submissions. Accountabilities & Responsibilities: Review medical record and checklist documentation for specific criteria to satisfy Medicare's medical necessity...ClaimsWork experience placement
$17 - $18.15 per hour
...Patient Access Specialist Ensemble is a leading provider of technology-enabled revenue cycle management solutions for health systems,... ...Service Collections) and billing processes to assist with a clean claim rate. Responsible for accurately screening of medical...ClaimsFull timeWork at officeLocal areaRemote workShift workNight shiftAfternoon shift- ...Health Institute is seeking a Clinical DRG RN auditor who will leverage expertise in MS-DRG and APR-DRG coding to audit inpatient claims. This role entails validating ICD-10 codes and DRG assignments while working remotely from anywhere in the U.S. The ideal candidate...ClaimsRemote jobRelocation package
- ...A leading claims adjusting firm in Minnesota is looking for Independent Insurance Claims Adjusters. This role provides an opportunity to assist individuals and businesses in recovery from disasters while offering flexible work conditions, autonomy, and competitive pay...ClaimsFlexible hours
- ...Wholesale Specialist Until Filled (CST) Minneapolis, MN, USA 50,000-60,000 per year Salary Full Time Benefits include paid... ...account balances by approving/denying any credit memo claims and refund requests. Communicate any changes in wholesale account...ClaimsFull timeTemporary workWork experience placementImmediate startRemote workFlexible hours
- ...Position Summary The Reimbursement Appeals Specialist is responsible for processing and managing prior authorization and claim denial appeals for the Walkasins System across third-party payers. The Appeals Specialist will gather supporting documentation, prepare and...ClaimsFull timeWork at officeFlexible hours
$24.32 - $40.16 per hour
...the Coding Supervisor, ED, OP Surgery & Observation, the Coding Specialist II analyzes and interprets clinical documentation to accurately... ..., CPT and HCPCS procedure codes as documented for accurate claim submission, as well as assign appropriate modifiers to bill appropriately...ClaimsRemote jobFull timeWork experience placement$80k - $100k
Old Republic National Title Insurance is looking for an Associate Claims Counsel to manage and resolve title insurance claims across the United States from a hybrid role in Minnetonka. This entry-level position is ideal for new attorneys eager to gain practical experience...Claims- ...Sam's Club | Medical, Dental, Vision, Rx + 401(k) with match + PTO + 100% Reimbursement of Tuition & Books | 200 American Boulevard... ...Receives merchandise and organizes receiving area; Tracks and processes claims for damaged goods; Maintains facility safety and follows forklift...ClaimsImmediate start
$60k
...Injury Prevention Specialist Position: Injury Prevention Specialist Location: Minnetonka, MN Type of Employment: Full-time Schedule... ...debt benefit program (in some regions) Comprehensive medical/RX, health, vision, and dental plan offerings Company-matching 4...Full timeCurrently hiringWork at officeRelocation packageMonday to Friday- ...provide insights to drive decision making. The role requires strong analytical skills and understanding of pharmacy claims, pricing, rebates, drug lifecycle and PBM contracting. The position is an onsite office role in Minnetonka, MN, with a typical schedule of three days...ClaimsWork at office3 days per week
$80k - $100k
...professional looking for a dynamic and rewarding career in the title insurance industry? Old Republic Title is seeking an Associate Claims Counsel to evaluate, manage, and resolve title insurance claims nationwide. If you have a keen eye for detail, strong problem‑...ClaimsWork at officeLocal areaRemote workFlexible hours$20.36 - $25.24 per hour
Starkey Hearing in Eden Prairie, Minnesota is seeking a Claims Specialist dedicated to supporting operations and ensuring insurance claim accuracy. The ideal candidate has a High School diploma (Bachelor’s preferred) and relevant experience in medical insurance billing....ClaimsHourly pay$112.7k - $193.2k
...implementation, program management, product management, operational leadership, or a related field Experience supporting healthcare, PBM, claims adjudication, or similar highly regulated operational environments Demonstrated experience managing intake processes, demand...ClaimsRemote jobMinimum wageFull timeWork experience placementWork at officeLocal area
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