A company is looking for a Health Plan Claims Educator to enhance the knowledge of the claims processing team.Key ResponsibilitiesDevelop and implement training programs for Claims, Medical Management, and Case Management staffMaintain knowledge of AHCCCS and Medicare regulations to ensure compliance and effective claims adjudicationAnalyze training needs and provide focused training based on data and audit findingsRequired QualificationsHigh School diploma or equivalentTwo years of training experience in an insurance or healthcare environmentThree years of experience with Case Management, Disease Management, or claims typesStrong working knowledge of Microsoft Office SoftwareKnowledge of medical terminology and coding (ICD-9, CPT-4)
Health Plan Claims Educator
A company is looking for a Health Plan Claims Educator to enhance the knowledge of the claims processing team. ...
Senior Claims Adjuster
This role serves as a claims subject matter expert (SME) and is responsible for incoming inquiries regarding current claims and escalated issues. Tracks and maintains all known issues, including the operational provider issue logs, and implements work plans to improve claims accuracy and systemic is...
Claims Research Specialist (36083)
This role serves as a claims subject matter expert (SME) and is responsible for incoming inquiries regarding escalated claims issues. Identify work plans to improve claims accuracy and systemic issues that decrease efficiency or provider satisfaction. The Claims Research Specialist is responsible fo...
Senior Claims Adjuster
This role serves as a claims subject matter expert (SME) and is responsible for incoming inquiries regarding current claims and escalated issues. Tracks and maintains all known issues, including the operational provider issue logs, and implements work plans to improve claims accuracy and systemic is...
Claims Adjuster (35406)
Responds to inquiry with clear explanation when claim is not adjusted. Performs any necessary claim adjustments for overturned determinations directly in the HealthRules system. Requests appropriate adjustment via AWD to the Claims BPO. Receives, tracks, completes and maintains the provider grids on...
Claims Quality Control Auditor (35027)
Review Neighborhoods claim process functions, including auto-generated adjudicated claims, based on provider and health plan contractual agreements and claims processing guidelines. The Claims Quality Control Auditor ensures organizational claim processing complies with contractual and regulatory re...
Case Manager RN
A company is looking for a Case Manager, RN (Remote). ...
FSRI - Part-Time Bilingual Community Health Worker
CHW is expected to complete home/community visits to support individuals as needed; and lead Pawtucket Central Falls Community Health Worker Networking Meetings; and participate in other programmatic meetings. This Community Health Worker position is co-located at Jenks Park Pediatrics office in Cen...
Community Outreach Worker
Certified Community Behavioral Health Clinic. Our programs include: Adult Mental Health, Youth and Family, Substance Use, Housing, Teen and Young Adult, Court Ordered, and Crisis Behavioral Health. Thrive Behavioral Health, the. Kent County, has been delivering mental health and substance use servic...
Case Manager- Access Services
Develop and implement case management plans and document services consistent with Thrive standards. Produce, complete, and maintain billing forms, logs, data collection forms, case management documentation and client records on time and in accordance with Thrive standards and state and federal regul...