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Under the direction of the Associate Director, reviews medical record documentation to identify pertinent diagnoses and/or procedures that require coding. The Certified Professional Coder reviews medical records to assure accurate specificity of diagnoses, procedures, and appropriate reimbursement for professional and/or facility charges. Effectively utilizes ICD 10, CPT,
Posted Today
Coordinates expirations with producers and/or account executive to obtain renewal and/or new business information. Keep producers fully informed of all important activities on their accounts. Meet weekly with producers to review upcoming renewals. Identifies policies requiring renewal attention for surplus lines or agency billed policies and sends carriers renewal changes
Posted 2 days ago
Zelis Healthcare, LLC
- Atlanta, GA / Plano, TX / Boston, MA / 3 more...
The Regulated Claims Settlement Coordinator supports the Claims Settlement Team through leading the review and response to disputed claims submitted through state and federal arbitration processes. The Regulated Claims Settlement Coordinator will be responsible for supporting Zelis' settlement offers and pricing after disputes have been filed to federal and state arbitrat
Posted 9 days ago
Reporting directly to the Finance Department, the successful candidate will be responsible for coordinating insurance activities, analyzing insurance data, ensuring compliance with regulations, and fostering effective communication between internal and external stakeholders. This role will report directly to the Controller and will interact with third party insurance brok
Posted 3 days ago
The Insurance Verification Specialist is responsible for obtaining verification of patient payer benefits and eligibility for services ordered. This includes but is not limited to private insurance, Medicare, Medicaid, and Rite care. Ongoing communication with medical billing department regarding authorization, re authorization, and retro authorization of visits Provide p
Posted 5 days ago
Manage incoming Bordereaux from program managers Review and ensure Bordereaux submitted have accurate template format Complete review of validation errors from Bordereaux ingestion, follow up with individual program managers for correction Ensure and maintain accurate data within the LOC, written and affiliate Bordereaux trackers Manage the LOC process Manage OFAC check p
Posted 10 days ago
Under the direction of the Associate Director, reviews medical record documentation to identify pertinent diagnoses and/or procedures that require coding. The Certified Professional Coder reviews medical records to assure accurate specificity of diagnoses, procedures, and appropriate reimbursement for professional and/or facility charges. Effectively utilizes ICD 10, CPT,
Posted Today
Inputs customer applications into the agency management system from the carrier rating system. Upload/submit application(s), photos, appraisals, etc. to be submitted to the insurance carriers for policy issuance. Checks new and renewal policies for accuracy in rating, typing and coverage. Ensure that these policies are delivered and/or mailed to the client. Monitors renew
Posted 27 days ago
Job Location Smithfield, RI Smithfield, RI Position Type Full Time   Travel Percentage Occasional Job Shift Daytime Job Category Professional / Experienced Description Position Overview (In Office) (Salary Range Min. 40k, Mid. 52k, Max 64k) This position is responsible for the overall Coordination of Benefits (COB) process within the Payment Integrity department. This
Posted 29 days ago
The FH authorization process is an essential function to FH's compliance with CMS regulations, NCQA standards, other applicable regulatory requirements, and customer expectations. The FH Authorization Coordinator serves to administer the FH prior authorization process as outlined in the Plan Member Handbook/Evidence of Coverage, departmental policies and procedures, and r
Posted 28 days ago
Summary Screens and interviews patients guarantors and/or family members when it appears that monies due or about to become due to Rhode Island Hospital are at risk in so far as their payment is concerned. Such patient contact to include when necessary off Hospital site contact. Responsibilities Participates in the monitoring control and follow up of the admission of non
Posted 2 days ago
Maintains expert level knowledge about industry; utilizes to manage pay models of complicated patient care plans and facilitates exceptional patient experiences as aligned with organizational values and mission. Acts as subject matter expert and guide to broad employee base, particularly providers, to educate and communicate on requirements, processes and adjustments need
Posted 3 days ago
Prior Authorization Specialist hybrid after onsite training! Full Time 8am 4 30pm Job Ref 28816 Category Clerical & Administrative Support Location Emerson Hospital, 133 Old Road to Nine Acre Corner, Concord, MA 01742 Department Patient Access Schedule Full Time Shift Day shift Hours 8 00 4 30 Job Summary Reports to the Direct of Patient Access, the position serves as the
Posted 21 days ago
Under general supervision of the Claims Administration Follow up Supervisor perform all clerical duties necessary to properly process patient bills to customers taking appropriate follow up steps to obtain timely reimbursement of each 3rd party claim and ensure the financial stability of the Hospital. Responsibilities Consistently applies the corporate values of respect h
Posted 5 days ago
At Boston Children's Hospital, the quality of our care and our inclusive hospital working environment lies in the diversity of our people. With patients from local communities and 160 countries around the world, we're committed to reflecting the spectrum of their cultures, while opening doors of opportunity for our team. Here, different talents pursue common goals. Voices
Posted 14 days ago
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