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Responsible for the most complex activities associated with maintaining ledger accounts and/or for developing financial statements and/or reports. Analyzes complex financial data and/or reports on the results and/or probable implications. Compiles financial information, processes journal entries into various accounts, and/or reconciles reports and/or financial data. Description 20% Exercises acc
Posted 13 days ago
Provides prompt, accurate, thorough and courteous responses to all customer inquiries. Performs research as needed to resolve inquiries. Description 65% Ensures effective customer relations by responding accurately, timely and courteously to telephone, written, web, or walk in inquiries. Accurately documents inquiries. 15% Initiates or processes adjustments or performs other research as needed t
Posted 15 days ago
The incumbent is expected to successfully complete the course curriculum for BlueCross' IT Entry Level Training Program (ELTP). Classroom training will focus on web/application development, system support, infrastructure or IT risk and compliance. On call will be required for some positions. Positions require a security clearance, which requires US citizenship to obtain. Description 50% Partici
Posted 15 days ago
Manages and coordinates the development of new business as needed to grow revenue for the company within identified markets and solutions. Identifies, pursues, and wins new business. Develops and recommends account plan and marketing approaches, and related changes as needed to reach sales goals and objectives. Prospects and develops leads leading to requests for proposals (RFP's) and sole source
Posted 15 days ago
Ensures that the Local Coverage Determination (LCD) process adheres to contract instructions. Creates, implements, and maintains educational tools to help providers reduce the submission of claims for non covered services and reduce the claims payment error rate. The error rate is a factor in awarding and renewing Medicare/other contracts. This position is apart of the MolDX Program by Palmetto GB
Posted 20 days ago
Responsible for the supervision and maintenance of the daily functions of Utilization Review/Review Nurses, Case Management, and/or Medical Review staff and specialty programs. Ensures appropriate levels of healthcare services are provided. Description 60% Manages day to day activities for assigned staff. Identifies training needs and verifies accuracy and timeliness of workflow functions. 20% S
Posted 20 days ago
Provides prompt, accurate, thorough and courteous responses to all telephone inquiries. Performs research as needed to resolve inquiries. Description 65% Ensures effective customer relations by responding accurately, timely and courteously to telephone inquiries. Accurately documents inquiries. 15% Initiates minor /clerical adjustments based on provider request or processes adjustments or perfor
Posted 26 days ago
Responsible for the supervision and maintenance of the daily functions of the following areas Utilization Review/Review Nurses, Case Management, Medical Review, Health/Disease Management, Quality Management, and/or Appeals, to include departmental staff and specialty programs. Responsible for all data collection for specialty programs and ensures appropriate levels of healthcare services are provi
Posted 27 days ago
Care management interventions focus on improving care coordination and reducing the fragmentation of the services the recipients of care often experience, especially when multiple health care providers and different care settings are involved. Taken collectively, case management interventions are intended to enhance client safety, well being, and quality of life. These interventions carefully cons
Posted 27 days ago
Coordinates the quality control program for the medical review area. Researches the Center for Medicare and Medicaid services (CMS) changes. Trains new staff and provides continuing education to clinical staff. Description 30% Reviews medical review decisions for accuracy and to ensure CMS instructions have been applied correctly. 25% Develops/implements the quality control program used as an in
Posted 27 days ago
Establishes and maintains provider networks for assigned lines of business. Serves as main contact for all recruiting or recontracting efforts and all contract questions or issues that arise with providers. Recommends and implements cost effective strategies while delivering high quality products to customers. Description 40% Conducts initial/renewal contract negotiations with providers. Perform
Posted 2 days ago
Responsible for responding to routine inquiries. Identifies incorrectly processed claims and completes adjustments and related reprocessing actions. Reviews and adjudicates claims and/or non medical appeals. Determines whether to return, deny or pay claims following organizational policies and procedures. Description 40% Responds to written and/or telephone inquiries according to desk procedures
Posted 1 day ago
Responsible for responding to routine inquiries. Identifies incorrectly processed claims and completes adjustments and related reprocessing actions. Reviews and adjudicates claims and/or non medical appeals. Determines whether to return, deny or pay claims following organizational policies and procedures. Description 40% Responds to written and/or telephone inquiries according to desk procedures
Posted 1 day ago
Provides prompt, accurate, thorough and courteous responses to all customer inquiries. Performs research as needed to resolve inquiries. Description 65% Ensures effective customer relations by responding accurately, timely and courteously to telephone, written, web, or walk in inquiries. Accurately documents inquiries. 15% Initiates or processes adjustments or performs other research as needed t
Posted 1 day ago
Responsible for analysis, design, programming, and implementation of complex applications tasks and projects. Devise feasible, logical procedures to resolve business problems through the use of computer resources. Formulate scope and objectives through research to develop or modify complex systems. Review detailed specifications and recommend modifications. Design, code, test and debug complex app
Posted 5 days ago
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