Claims processing refers to the insurance company's procedure to check the claim requests for adequate information, validation, justification and authenticity.
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Job Description Description:Responsible and accountable for the accurate and timely claims processing of all claim types. Claims must be processed with a high level of detailed quality and in accordance with claims payment policy and by the terms of our customer/provider contractual agreements.Essential Functions:- Adjudicate claims and adjustments as required.- Resolve claims edits and suspended claims.- Maintain and update required reference ma...
Job Summary. This position is responsible for the daily adjudication/review of medical, dental, vision, mental health and FSA claims. Claims may be auto-adjudicated or manually processed. Ensures claims are adjudicated accurately and in a timely fashion. Incumbent must keep abreast of changing regulations, products, and procedures. Maintains relationships and serves as a liaison to outside sales staff, employers, administrators, plan members, pro...
POSITION SUMMARY/RESPONSIBILITIES. Responsible for development and maintenance of claims auditing program for all lines of business to improve claims processing standards and to monitor the quality of service delivered to our customers. Identifies processor and phone representative training needs that can be used to improve performance. Requires knowledge of claims processing for HCFA and UB92 for both commercial and Medicaid programs and knowled...
POSITION SUMMARY/RESPONSIBILITIES. Responsible for development and maintenance of claims auditing program for all lines of business to improve claims processing standards and to monitor the quality of service delivered to our customers. Identifies processor and phone representative training needs that can be used to improve performance. Requires knowledge of claims processing for HCFA and UB92 for both commercial and Medicaid programs and knowled...
The Warranty Administrator is responsible for. Recording and processing claim information to manufacturer specifications. Ensure warranty repairs are carried out to customer satisfaction. Investigate overdue, unsettled and short-paid claims. Check, verify, process, document and file warranty forms. Receive, reconcile and record payment summaries from manufacturers/concessionaires. Working knowledge of activities, methods, procedures and policies ...
Description. This position is responsible for maintaining routine auditing functions and providing feedback on departmental activities, to assure compliance with all health plan and regulatory agencies, including CMS, DMHC, and DHS. This position includes the responsibility for routine hospital and professional audits, complex audits on individual or random, training and focused claims to identify exceptions to established claims adjudication req...
Job Details. Job Location. San Diego - San Diego, CA. Salary Range. $25.00 - $32.00. Description. At Espire, you’re empowered to use your powers. You’ll have the freedom from all the barriers, limitations, and frustrations that keep you from focusing on patient care. We’re combining the world’s best dental care and technology with inspired hospitality. If you’re amazing and you’d like to have fun, be your best, and spread confidence and joy one s...
We are currently looking to hire multiple individuals to process applications for a short term government program. This is a great opportunity to get your foot in the door of a growing, national company. In this role you will be processing paper applications and assessing eligibility for the program based on household size and income. You will also be reaching out to applicants to confirm information, entering the claims in the system and then se...
Description. Primary responsibilities will be to ensure that all facets and requirements of a multi-physician practice including billing and A/R, insurance claim processing, and any other duties as assigned are completed. Additional Skills & Qualifications. This individual should be able to compile data, planning/organization, serve as a liaison between the department and the company to ensure that the needs are communicated and met with a high p...
Apply. Job Type. Full-time. Description. With general supervision, verify claims processing, system accuracy, and data entry accuracy, identify and communicate errors, and track errors for trends.Essential Functions Perform scheduled quality assurance audits for both In-Network and Out-of-Network claimsRecord and track audit errors. identify trends and opportunities to improve qualityProvide feedback from errors and submit quality assurance audit...
Overview. At the Cancer Center of Kansas, we value each and every employee for their life-saving expertise and the role they play in making our patients' lives as easy and comfortable as possible. Our employees are our most valuable resource. They help us create the warm and caring environment that's the foundation for some of the best cancer research and care in the country. If you would like to join a team dedicated to improving lives every day...
A large medical group in Fresno is looking to add on expereinced claims processing reps to join the team onsite. Highlights. Location: Onsite in Fresno. Pay: $19. Schedule:M-F. Low turnover deparment and lots of opportuntiy for career advancement. Job Description. Maintain multiple groups. Process CMS-1500 claims. Process UB-04 claims. Process high dollar claims. Process JAA / BlueCard claims. Interpret individual group SPD’s and apply benefits a...
