Presenting a concise medical summary within each appeal. Composing clinical appeal letters to send to payers for denial reconsiderations. Determining root cause of each denial and apply company-specific coding. Qualifications Include: State RN or LPN License required (Active/Inactive)
Travel to Zachary, LA at least once per month. Associates Degree in Billing or related field. Excellent verbal and written communication skills. Problem Solving/ Analysis. 3-5 year's Medical Billing and Coding experience. Proficient in Microsoft Office Suite with concentration in Excel.
Developing medical trend and operating methodologies and assumptions. Qualifications Include: Must be able to present findings and recommendations. Medicaid background with knowledge of Medicaid Regulations and/or Facets claims platform.
Obtaining appropriate medical information to ensure accurate assessment of a risk. Applicants must meet the following qualifications: Attending industry seminars, courses and workshops. Degree holder with a minimum 5 years' medical underwriting experience.
Completing valuations for corporate and public sector clients. Providing IBNR reserve calculations for self-insured medical plans. Applicants must meet the following qualifications: 5+ years of experience. ASA or better. Ability to sign off on OPEB reports.
Equivalent work experience. 1-2 years experience managing claims. Workers’ compensation experience as TPA Medical Only Examiner or MCO Case Specialist. Working knowledge of Ohio and/or Washington workers’ compensation rules and regulations.
High school diploma or equivalent. 2 year as a medical claims processor. Or, 2 years of office experience in a customer service or insurance environment. Ability to learn and apply VA benefits, policy, and federal regulation. Ability to learn all VA claims processing methodologies and systems.
Have a minimum of 2 years experience in medical-oriented scheduling environment. Adept at handling large call volumes. Have a working knowledge of EPIC/Cerner and/or PHS. Able to efficiently schedule radiology and diagnostic procedures. Have experience with basic insurance guidelines.