Average salary: $103,919 /yearly
More stats ...complaints in the event they feel they were inappropriately charged - Billback Coordinator will provide reasoning, evidence, and final adjudication to resident
# Security Deposit Adjudication : Review turn scopes following resident move-outs to determine whether or not we...
Suggested
Remote job
Full time
...security clearance. The Defense Industrial Security Clearance Office (DISCO), an agency of the Department of Defense, handles and adjudicates the security clearance process. More information about Security Clearances can be found on the US Department of State government...
Suggested
Holiday work
Full time
Contract work
Temporary work
For contractors
Work experience placement
Remote job
Work from home
Flexible hours
...support our customer, a major Healthcare Insurance organization. Under direct supervision, the selected candidate will review and adjudicate paper/electronic healthcare/medical claims and will determine proper handling and adjudication of claims following organizational...
Suggested
Permanent employment
Contract work
Remote job
$90k - $95k
...organization.
Preferred Qualifications
Experience working within government healthcare technology, home care, and/or claims adjudication.
Experience with small to medium scale project management.
Experience working with tools such as JIRA, Zendesk, Confluence...
Suggested
Holiday work
Full time
Casual work
Remote job
Flexible hours
...pharmacies, physicians, or members professionally and providing accurate resolutions
Troubleshooting issues with our online claims adjudication system
Entering overrides and prior authorizations
Real-time eligibility management
Assisting other departments as...
Suggested
Remote job
Full time
Work experience placement
Flexible hours
$19 - $21 per hour
...drug screen prior to their date of hire.
The ability to undergo a Public Trust background investigation and receive a favorable adjudication.
US Citizenship for at least 5 years.
This position will accept and review new applications and resumes no less than 5...
Suggested
Hourly pay
Full time
Contract work
Remote job
Home office
Night shift
...Knowledge: Good understanding of the tenets of health insurance, the managed care model, industry coding/policy standards, the claim adjudication process, and issues related to fraud waste and abuse. Ability to apply this knowledge to the development & evaluation of new...
Suggested
Holiday work
Full time
Work experience placement
Immediate start
Remote job
Flexible hours
...resulting member experience. Explains HealthEquity’s administrative capabilities as a result of these decisions, including claims adjudication and payment; debit card functionality; payroll, enrollment and eligibility file interactions; carrier integrations; compliance...
Suggested
Full time
Work experience placement
Remote job
...inbound files from external partners.
Monitor ongoing Engineering operations and provide troubleshooting support for our claims adjudication processes including eligibility, accumulators, and reporting.
Support new partner integrations and client implementations....
Suggested
Remote job
Holiday work
Temporary work
Work experience placement
Flexible hours
...strategy. Core functions of this role include: applying formulary changes across systems, building formulary programs within the adjudication system, communicating negative changes with internal and external partners and leading testing initiatives. The Formulary...
Suggested
Remote job
Holiday work
Temporary work
Flexible hours
...(including insurance payments, capitation payments, patient payments, remittance items and voided charges). Reconciliation of re-adjudicated claims/payer takebacks.
Management of the accounts receivable (AR) including analysis of the aged AR, looking for root cause issues...
Suggested
Full time
Local area
Remote job
Home office
...analysis with prior experience in supporting or working with software programs and client systems (i.e. coding and billing systems, adjudication systems, etc.).
Strong interpersonal skills required. Able to anticipate, identify and resolve simple to complex problems....
Suggested
Holiday work
Full time
Contract work
Immediate start
Remote job
...security clearance. The Defense Industrial Security Clearance Office (DISCO), an agency of the Department of Defense, handles and adjudicates the security clearance process. More information about Security Clearances can be found on the US Department of State government...
Suggested
Holiday work
Full time
Contract work
Temporary work
Work experience placement
For subcontractor
Remote job
Outdoor
Flexible hours
...guidance to the research & development efforts of our Medical Policy and Solutions teams
Have in-depth knowledge of claims, claims adjudication, medical policy edits and configurations
Inspire trust and credibility, deliver on commitments, provide value-add analytics...
Suggested
Holiday work
Full time
Immediate start
Remote job
Work from home
...CorVel University Claims Trainee is an entry level position for those who are interested in developing a career path in claims adjudication within Workers' Compensation, Liability, or Subrogation. The CorVel University Claims Trainee will participate in CorVel Claims...
Suggested
Hourly pay
Minimum wage
Full time
Traineeship
Local area
Remote job
Work from home
Flexible hours
$53k - $63k
...insurance benefit eligibility and coverage information for patients. This role requires experience with eligibility and claims adjudication for multiple states’ Medicaid, Managed Medicaid, and commercial plans.
What You’ll Do:
Monitor insurance accounts receivable...
Remote job
Full time
Relocation
Shift work
$24 - $27 per hour
...for
the interpretation and data entry of moderately complex prescriptions,
prior authorization processing, and troubleshooting adjudication issues.
How You Will Make an Impact
Primary duties may include, but are not limited to:
~ Verifies member information...
Full time
...-04 and to the payor’s claims processing system. Responsible for validating appropriate payment was received by the client upon adjudication of the claim.
Responsible for providing education and feedback to clients after audit is completed. Responsible for staying current...
Part time
Work experience placement
Local area
Immediate start
Remote job
Flexible hours
...design changes. Ensures the synchronization of accurate pharmacy benefit information into internal and external pharmacy claims adjudication systems. Participates in the development of strategies that leverage pharmacy coverage/benefit and utilization management strategies...
Full time
Remote job
Shift work
...meticulous attention to detail and the ability to efficiently process incoming requests, ensuring data accuracy to optimize claims adjudication.
Essential Functions :
Receive provider information from external sources for system updates.
Analyze incoming data...
Hourly pay
Permanent employment
Contract work
Temporary work
...functions.
Basic Qualifications:
Experience
~ Minimum four (4) years of medical claims in an health plan environment adjudication experience (HMO, PPO, Indemnity environment). Which includes one (1) year of processing high complexity claims. IE: Adjustments,...
Full time
Contract work
Local area
Remote job
Shift work
...who identify with
underrepresented groups to apply.
Applicants are not obligated to disclose expunged juvenile
records of adjudication, arrest, or conviction as part of the
application process.
*Learn more about our perks and benefits here: (
Human...
Remote job
Full time
Work visa
...guidelines to resolve claim denials with a goal of one contact resolution.
Identified and resolved denied, non-paid, and/or non-adjudicated claims and billing issues due to coverage issues, medical record requests, and authorizations.
Recommend accounts to be...
Hourly pay
Full time
Private practice
Offshore
Flexible hours
...managers to resolve issues related to local collective bargaining group agreements, licensure validation, and background investigation adjudication.
Supports and maintains HR compliance with local, state, and federal laws, standards, and regulations by processing and...
Full time
Contract work
Local area
Remote job
Shift work
...0
Collects data under the supervision of a site lead, shift lead, or experienced data collector.
Reviews collected data to adjudicate any anomalies identified by the site lead/data analysis personnel.
Strong written and oral communication skills required, as well...
For contractors
Shift work
...responsible for screening, reviewing, evaluating online entry, correcting errors and/or performing quality control review and final adjudication of paper/electronic claims. Determines whether to return, deny or pay claims following organizational policies and procedures....
Full time
Local area
...workflow.
2. Responsible for outbound calls and/or status inquiries via payers website validating receipt of medical claims and adjudication status within established timeframes. Display competent ability to access, navigate, and manage account information through...
...That’s why HealthRules Payer has been ranked number one its class among CAP Solutions. Besides delivering 90%-97% first-pass auto-adjudication rates and 99%+ accuracy, it enables our customers to react swiftly to the latest regulatory shifts and competitive pressures. It...
Permanent employment
Full time
Temporary work
Remote job
Afternoon shift
...Bamboo
Ability to define and build scalable CI/CD pipelines
Additional Requirements: DoD SECRET Security Clearance or Fully Adjudicated T3 Background Investigation
Min Citizenship Status Required : U.S. Citizen - No Dual Citizenship
Physical...
Full time
Work experience placement
Remote job
...PURPOSE:
Under direct supervision, reviews and adjudicates paper/electronic claims. Determines proper handling and adjudication of claims following organizational policies and procedures.
ESSENTIAL FUNCTIONS:
60% Examines and resolves non-adjudicated claims to identify...