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$40k - $52.3k
...Join Our Caring Community The Claims Processing Representative reviews and adjudicates complex or specialty claims, submitted either via... ...are leading to a better quality of life for people with Medicare and Medicaid, families, individuals, military service personnel...ClaimsTemporary workWork at officeHumana
Hollywood, FL1 day ago$121.79k - $158.32k
...is located in the Department of Health & Human Services (HHS), Centers for Medicare & Medicaid Services (CMS), Center for Medicare, Provider Billing Group Division of Supplier Claims Processing. About the Role As a Health Insurance Specialist (Claims Processing and Systems...Claims$138.9k - $191k
Become a part of our caring communityThe Director, Claims Processing and Payment Integrity oversees adjudication of claims and uses technology... ...experience to ensure success in the role8 or more years of Medicare and/or Medicaid claims management experienceAble to...ClaimsFull timeContract workTemporary workApprenticeshipWork at officeCenterWell Home Health
Miramar, FL4 days ago- ...unpaid, partially paid, and denied hospital claims to determine the cause of the outstanding balance Communicate with commercial, Medicare, Medicaid, and managed care payers... ...adjudication, denials, reimbursement, and payer processes Experience researching and resolving...Claims
District Partners
Gaithersburg, MD3 days ago - ...Process and submit medical claims for Medicare, Medicaid, commercial insurance, and managed care plans Review claims for accuracy, completeness, and compliance prior to submission Follow up on unpaid, denied, or rejected claims and assist with appeals and corrections...ClaimsWork at office
Jobtailor
Richmond, VA1 day ago - ...using medical coding procedures. Examines claims and verifies insurance eligibility.... ...Files Partners HMO, Michiana Healthnet, Medicare, Medicaid and other insurance types daily... ...to regulatory agency requirements, survey process and compliance. Complies with established...ClaimsShift work
Beacon Health System
South Bend, IN3 days ago - ...Prepare and submit insurance claims for home infusion services, including medications, nursing, and supplies Process electronic pharmacy claims to Medicare Part D, Medicaid, and commercial insurance plans Verify prescription reimbursement data is complete, accurate, and...ClaimsWork at office
Jobtailor
Overland Park, KS2 days ago - ...Job Description Job Description Position Summary Responsible for accurately and efficiently processing insurance claims, primarily Medicaid, Medicare and Medicare and Medicaid HMO’s. Job Duties Monitor the progress of insurance claims from submission...Claims
Hudson Regional Hospital
Clifton, NJ19 days ago - ...functional team to support ongoing modernization efforts for the Medicare Claims ecosystem. This work includes determining how to modernize... ...environment, where checks and compliance is built into the process of building software. This can make the path to production slower...ClaimsFull timeFor contractors
Nava Pbc
Washington DC1 day ago - ...handling all complex or past-due third-party billing claims for the purpose of securing reimbursement of services (Medicare, Medicaid, Managed Care); Serves as the "... ...account after all insurance payments have been processed if the resident responsible portion doesn't make...ClaimsContract work
Lutheran Senior Services
Saint Louis, MO3 days ago - ...and affordable to all populations across the ACA Marketplace, Medicare, and Medicaid. NeueHealth delivers clinical care to health... ...translating the information into codes that insurers use to process claims from patients. Their duties include confirming treatments with...ClaimsWork at office
Centrum Medical Ventures
Miami, FL1 day ago $24 - $28 per hour
Mindful Therapy Group in Seattle, WA, is seeking a claim specialist to independently resolve complex insurance balances, denials, and claim-processing issues across commercial, Medicare, and Medicaid payers. The role is fully in-office, 8:30am-5:00pm, Monday-Friday, with...ClaimsHourly payWork at officeMonday to Friday- ...populations across the ACA Marketplace, Medicare, and Medicaid. NeueHealth delivers clinical... ...for the accuracy of the super bill/claim prior to transmission to payer, including... ...part of the super bill/claim validation process. Prepare and review super bill/claims...Claims
Centrum Medical Ventures
Miami, FL3 days ago - ...oriented Insurance Account Resolution Specialist to manage claims after submission to Medicare HMOs, Medicaid MCOs, and facilities. The role focuses on... ...with strong emphasis on follow‑through, analytics, and process improvement in a fast‑paced environment. #J-18808-...ClaimsRemote jobMonday to Friday
- ...Job TitleEssential Job Functions: Files Medicare, Medicaid, Worker's Compensation and private insurance claims for EMS, both electronically and on paper; contacts debtors... ..., arithmetic and vocabulary; knowledge of word processing and spreadsheet processing software.Skills/...ClaimsFull timeWork at officeLocal area
City of Beaumont
Beaumont, TX4 days ago - ...company, seeks a Government Programs Operations Analyst (EGWP) to support Medicare Part D implementation and ongoing compliance with CMS regulations. The role focuses on enrollment, claims processing, member services, and reporting. The ideal candidate brings 3+ years of...ClaimsLocal area
Capital Rx
Denver, CO1 day ago - ...healthcare providers rendering medical care) with Medicare Part B drug coverage inquiries, and prior... .../member call center or helpdesk Process prior authorization requests Knowledge... ...NDC drug codes, therapeutic classes and claims processing preferred Call Center or...ClaimsApprenticeshipLocal area
LanceSoft
Detroit, MI1 day ago - 1. Review and submit clean claim for payment Reviews and corrects all claim edits in the... ...department. Review and correct all Medicare claim edits for submission to WPS. Review... ...follow-up. Works with payers on denials with processes including, but not limited to, phone...ClaimsWork at office
Shenandoah Medical Center
Shenandoah, IA5 days ago $85.45k - $133.14k
...About the Role READY TO USE YOUR CLINICAL EXPERTISE TO PROTECT MEDICARE? Join the Center for Program Integrity as a Nurse providing... ...CMS components on data interpretation, recovery audits, claims processing, medical review, and appeals to ensure accurate clinical Medicare...ClaimsFor contractorsCenters for Medicare & Medicaid Services
Riverdale, MD2 days ago- ...professional coding guidelines, centers for Medicare and Medicaid (CMS) guidelines, and... .... Meets deadlines to expedite the billing process and to facilitate data availability for providers to ensure the timeliness of claim submissions. Reviews outpatient medical records...ClaimsWork at office
Aya Healthcare
Fort Lauderdale, FL3 days ago - ...Title: Medicare SME- Payment Integrity Analyst Duration : 12 months Location... ...This resource will implement a process to test end-to-end common Medicare Advantage... ...issues quickly across the inputs that support claims payment (medical policy, authorization, benefits...ClaimsRemote work
RIT Solutions, Inc.
Lutherville Timonium, MD5 days ago - ...should have strong health care domain experience and should have good knowledge of Medicaid and Medicare. Candidate should have hands-on experience on claims processing and adjudication processes. Must have good experience in reference code/data sets required in...ClaimsRemote work
The Dignify Solutions, LLC
United States1 day ago - ...categories, CPT, HCPS CMS 1500 FORM, HEDIS, MRA, Super Bill, Electronic Claims Submission and Clearing House Operations, EOB and payments, denials and appeals, Billing, Collections and Appeals processes and Medicare and Medicare Advantage billing methodology and processes....Claims
Miami Beach Medical Group
Doral, FL2 days ago - ..., and smooth facility function. You will manage accounts receivable, support billing operations, process claims, supervise resident trust funds, and ensure timely Medicare/HMO billing while providing training and backup coverage for the office. A strong focus on organization...ClaimsWork at office
Creative Solutions in Healthcare
Dallas, TX3 days ago - ..., compliance, and complete reimbursement Prepare and submit claims to Medicare, Medicaid, commercial insurers, and other third-party payers... ...and problem-solving skills are essential for managing billing processes and resolving issues effectively. Highest-signal resume...Claims
Jobtailor
Montana4 days ago - ...based care arrangements, including ACOs, Medicare, Medicaid, Medicare Advantage,... ...is responsible for analyzing healthcare claims, utilization, cost trends, risk adjustment... ...of actuarial data structures, reporting processes, and repeatable analytical tools.Communicate...ClaimsContract work
Wilmington Health
Wilmington, NC4 days ago - ...and enter moderately complex prescriptions Process prior authorization requests and... ...prior authorization requests and ensure Medicare compliance Inform relevant parties of prior... ...territory PTCB Certification preferred Pharmacy claim adjudication experience preferred...ClaimsWork at office
Jobtailor
California, MO4 days ago - ...various referral sources • Ensure hiring processes are followed and recruiting efforts... ...and collection efforts to generate clean claims Requirements • Valid Driver’s License... ...day. HHH As an employer accepting Medicare and Medicaid funds, employees must...ClaimsFull timeRelocation package
Aveanna Healthcare
Pelham, AL3 days ago - ...surgical centers across the US. You will handle claim submission, denial management, A/R follow... ...clean claims across Medicare, Medicaid, and commercial payers with ? 9... ...successfully complete the entire recruitment process, your profile will be added to our talent...ClaimsImmediate startRemote work
Virtual Teammate
Glendale, CA5 days ago - ...hMetrix is a healthcare data analytics company that processes large volumes of claims data from insurers and state governments to support some of... ...resources for that — but you must speak the language of Medicare claims fluently enough to direct analytic work credibly...ClaimsFor contractorsWork at officeRemote workFlexible hours1 day per week
hMetrix
New York, NY3 days ago
