Position Summary. The Claims Examiner III is responsible for processing submitted electronic claims to ensure proper filing procedures and that processing guidelines and rules have been followed. The Claims Examiner III also validates claim or referral submissions to determine, review, or apply appropriate guidelines, coding, member identification processes, provider selection processes, claim coding, including procedure, diagnosis and pre-coding...
Position Summary. The Configuration and Data Integrity Manager is responsible for implementing and interpreting the organization's overall claims, provider configuration, eligibility and provider database management, security, and operations. The Configuration Manager will work with internal departments and external organizations to assure secure data exchanges, integrity, reliability, and availability. plans, organizes and coordinates activities...
In office - Not remote. Position Summary. The Utilization Management Specialist I focuses in the review of prior authorizations and medical records by acting as a liaison between the medical directors and the providers. Coordinates transmission of time sensitive documents in accordance with regulatory compliance and performs regulatory reporting for health plan and internal compliance requirements. The specialist also supports the Utilization Man...
