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... payer decisions, collection attempts, and payment plan arrangements • Coordinates with ... and time, directions to facility) Payment Management: • Creates accurate estimates ... collects payments or makes appropriate..
Job Information Humana Special Investigations Professional / Lab Investigator (Fraud, Waste & Abuse) Remote/Virtual in US in Tampa Florida Description The Fraud and Waste Professional 2 conducts investigations of allegations of ..
Job Information Humana Pharmacy Claims Specialist, Remote in Tampa Florida Description The Pharmacy Claims Representative 2 adjudicates pharmacy claims and process pharmacy claims for payment. The Pharmacy Claims Representative 2 performs ..
Description The Claims Research & Resolution Professional 2 works with enterprise shares team comprised of calls/claims/contracting and external provider associates researching the resolution to a pending inquiry. Understands department, segment, and ..
Description The Care Manager, Telephonic Nurse 2 employs a variety of strategies, approaches and techniques to manage a member's physical, environmental and psycho-social health issues. Identifies and resolves barriers that hinder ..
The Patient Government Accounting Analyst plays a crucial financial role in minimizing bad debt and maximizing revenue to meet Genesis HealthCare Business Excellence goals. RESPONSIBILITIES/ACCOUNTABILITIES:Ensure claims/bills are produced according to payor ..
Description The Behavioral Health Medical Director responsible for behavioral health care strategy and/or operations. The Behavioral Health Medical Director work assignments involve moderately complex to complex issues where the analysis of ..
Description The Medical Record Retrieval Specialist (Risk Adjustment Representative) travels to provider offices within the region and scans medical records into a secure system. The records are reviewed by Humana's Coding ..
... looking for an experienced Senior Healthcare Investigator to join its industry ... Qualifications Bachelor's degree or significant healthcare fraud and investigation experience At ... At least 3 years of..
Description The Supervisor, Pre-Authorization Nursing reviews prior authorization requests for appropriate care and setting, following guidelines and policies, and approves services or forward requests to the appropriate stakeholder. The Supervisor, Pre-Authorization ..
Description The Medical Director relies on fundamentals of CMS Medicare Guidance on following and reviewing appeals for Medicare Part C Line of Business. The Medical Director provides medical interpretation and determinations ..
Description iCare is seeking an Enrollment Specialist who will support the iCare enrollment processing duties for all lines of business including Medicare, Medicaid, Family Care Partnership (FCP) and BadgerCare Plus. Responsibilities ..
Job Summary (External): u003cpu003eu003cemu003eu003cspanu003eApria Healthcare’s mission is to improve the ... Already an industry leader in healthcare services, we provide home respiratory ... for audit and documentation purposes.u003c/spanu003eu003c/liu003enu003cliu003eu003cspanu003eCollect payment and..
Description The Risk Management Lead - Home Health works as a partner with Home Solutions teams to evaluate and analyze business processes, potential issues, and strategic opportunities to minimize risk, ensure ..
Description The UM Compliance Letters Specialist/Coordinator 2 contributes to administration of utilization management in the Compliance department. The UM Administration Coordinator 2 performs varied activities and moderately complex administrative/operational/customer support assignments. ..
Description The Risk Adjustment Representative Specialist travels to provider offices within the region and scans medical records into a secure system. The records are reviewed by Humana's Coding staff. How we ..
... is looking for an experienced Healthcare Investigator to join its industry ... areas Bachelor's degree or significant healthcare fraud and investigation experience At ... At least 1 year of..
... Qualifications Minimum 5 years of healthcare fraud investigations and/or auditing experience ... of Florida and Wisconsin Medicaid healthcare payment methodologies Strong organizational, interpersonal, and ... the required qualifications. Understanding..
Job Information Humana Senior Integration Specialist - Cloud in Tampa Florida Description The Senior DevOps/Cloud Solutions Engineer Enables the automation of software code deployment by eliminating functional silos existing between development ..
... 40 market leader in integrated healthcare whose dream is to help ... and enrollment, Claims, Encounter Reporting, Payment Integrity, Member Call Center, Provider ... (typically 8 years) working in..
Description The Medical Director relies on medical background and reviews health claims. The Medical Director work assignments involve moderately complex to complex issues where the analysis of situations or data requires ..
