The Provider Management Analyst is tasked with verifying provider information and auditing claims documentation such as itemized bills and medical records. Responsibilities also include ensuring the accuracy of patient, provider, and client information to facilitate proper request delivery.
Remote Jobs & Work From Home Opportunities (206,832)
The Medical Case Manager provides in-person and telephonic case management to injured workers, collaborating with patients, providers, and employers to facilitate recovery. Responsibilities include assessing treatment plans for appropriateness and medical necessity, attending provider visits, and developing long-term care strategies.
The Senior Claims Specialist manages complex Workers' Compensation claims by confirming coverage, determining compensability through investigation, and establishing reserves and authorizing payments. This role also develops action plans, coordinates return-to-work efforts, manages subrogation and litigation, and communicates claim status to customers and claimants.
The Claims Supervisor manages a team of direct reports, ensuring adherence to quality, productivity, and customer service standards while complying with company policies. This role involves supervising daily operations, assisting with staff onboarding, providing technical guidance on complex claims, and acting as a liaison for final claim resolutions.
The role involves acting as a Team Coach to foster effective work environments, enable self-organization within development teams building the Enterprise-IoT-Suite (bxSUITE), and mediate conflicts. Additionally, the coach supports collaboration across multiple teams to resolve dependencies and systemic issues, ensuring the stability and scalability of the technological foundation.
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The role involves acting as a Team Coach to foster effective work environments for development teams building the Enterprise-IoT-Suite (bxSUITE) and as an Agile Coach to support collaboration across multiple teams, resolving dependencies and systemic impediments. The mission is to enable the development of a stable and scalable technological foundation while driving a culture focused on continuous improvement for customer benefits.
The Medical Case Manager will provide in-person and telephonic case management to injured workers, collaborating with patients, providers, and employers to facilitate recovery. Responsibilities include assessing treatment plans for appropriateness and necessity, attending various provider and facility visits, and conducting home evaluations.
The Bill Review Analyst is tasked with reviewing, auditing, and data-entering medical bills across multiple states and lines of business to ensure compliance with fee schedules, guidelines, and discounts. Essential functions include auditing bills for appropriateness and meeting high accuracy and keystroke targets.
FINANCIAL REPORTING MANAGER
Arizona Department of Administration
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Part Time
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11 Weeks Ago
Arizona Department of Administration
The manager will lead financial operations for the Targeted Investments (TI) health care provider incentive payment program, overseeing fund distribution, expenditure monitoring, and delivering high-impact financial reporting to executive leadership. Key duties include determining payment amounts based on performance metrics, supervising staff conducting data analysis, and overseeing program systems development.
Key Account Managers are responsible for building and improving relationships with clients, suppliers, and partners while driving client engagement through various KPIs like subscription upgrades and pipeline generation. They also focus on ensuring maximum client satisfaction by educating clients on products and promptly resolving any complaints or issues.
The Knowledge Center Representative assists claimants, providers, and other interested parties by receiving and answering telephonic inquiries. This role focuses on delivering high-quality inbound and outbound customer service with an emphasis on accuracy and first call resolution.
CA Senior Liability Claims Specialist
CorVel Corporation
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Full Time
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11 Weeks Ago
CorVel Corporation
The Senior Liability Claims Specialist manages mid to complex Auto and/or General Liability claims, focusing on achieving optimal outcomes for the company and clients. Responsibilities include receiving claims, confirming coverage, investigating, determining compensability, establishing reserves, and authorizing payments within limits.
The Appeals Representative is tasked with reviewing, analyzing, and responding to provider inquiries and appeals received through various communication channels, ensuring adherence to regulatory guidelines and client policies. This role requires accurately setting up and efficiently initiating the appeals process in a timely manner to support overall operations.
The Itemization Review Nurse analyzes charges on a UBIB submitted by a medical facility by collecting supporting data to determine the accuracy of billed charges. This role requires appropriate documentation of work and final conclusions in the designated computer program.
Manufacturing Engineer
Industrial Technologies Group, an affiliate of The Heico Companies
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Full Time
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11 Weeks Ago
Industrial Technologies Group, an affiliate of The Heico Companies
The Manufacturing Engineer develops and implements optimal, cost-effective manufacturing processes aligned with product specifications and quality standards, often working directly on the shop floor to analyze layout, workflow, and utilization to reduce waste. This role involves leading continuous improvement efforts using Lean Manufacturing tools and collaborating with design staff to ensure efficient production methods.
The supervisor is responsible for managing the daily production flow of a designated department, which may involve human resources and customer service functions, while promoting a positive influence over Setup Analysts. Key duties include implementing new business development, directing daily employee operations, setting department goals, and ensuring adherence to company policies and HIPAA compliance.
The position is responsible for prospecting, qualifying, and generating new sales leads to support Account Executives by identifying prospects from various sources like inbound leads, lists, and research. Responsibilities include developing new business via phone, email, and social media, cultivating prospect relationships, and managing data in the CRM.
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The Claims Training Specialist develops curricula to ensure adherence to best practices, improves quality metrics, and equips the claims workforce to meet client requirements. Responsibilities include conducting classroom, virtual, and field training, developing materials, and monitoring new hires.
The Claims Specialist manages lower-level, non-complex workers’ compensation claims within delegated authority, focusing on confirming coverage, determining compensability, establishing reserves, and authorizing payments. They are responsible for communicating claim status to customers, claimants, and clients while adhering to guidelines and assisting with more complex claims when necessary.
The Medical Case Manager facilitates recovery for injured workers by providing in-person and telephonic case management, collaborating closely with patients, providers, and employers. Responsibilities include assessing treatment plans for appropriateness and medical necessity, attending provider visits, and implementing necessary care like negotiating equipment delivery.
The Professional Review Nurse analyzes medical services to determine the appropriateness of charges on medical bills and reviews medical reports to assess the quality of medical care provided. Key duties involve identifying review necessity, collecting and analyzing data, and using clinical expertise to detect inappropriate billing practices and errors.
Online Course Facilitator - Dep't of Government
Eastern Kentucky University
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Full Time
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11 Weeks Ago
Eastern Kentucky University
The Online Course Facilitator supports the delivery of high-enrolled online courses by fostering regular and substantive interaction with assigned students under the direction of the Instructor of Record (IOR). This role also involves providing timely and meaningful assessment of course assignments as directed by the IOR and maintaining consistent communication and collaboration with the IOR.
The Closing Team Lead monitors and tracks all closing processes, running queries, maintaining reports, and overseeing training for new Closing Analysts. This role also involves assisting analysts with escalations, serving as final Quality Control, tracking errors, and leading meetings.
This position is responsible for all sales activities, including identifying, qualifying, developing, and closing revenue from both new customer acquisition and expansion of existing solutions focused on software and payment processing for Public Sector clients. Key duties involve generating revenue using industry expertise, developing account plans, building trusted advisor relationships, and managing sales activities within the CRM system.
The Telephonic Case Manager coordinates resources and develops cost-effective, personalized care plans for ill or injured individuals, aiming to support quality treatment and timely return to work. Responsibilities include providing medical case management, assessing treatment plan appropriateness, and communicating recommendations to physicians and payers.
The Appeals Representative is tasked with reviewing, analyzing, and responding to provider inquiries and appeals received through various communication channels, ensuring adherence to regulatory guidelines and client policies. This role requires accurately setting up and efficiently initiating the appeals process in a timely manner to support overall operations.
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The Medical Only Claims Specialist manages non-complex, medical-only workers’ compensation claims under close supervision, supporting departmental goals. Essential functions include receiving claims, confirming coverage, determining compensability, establishing reserves, and communicating claim status to relevant parties.
The Telehealth Billing agent is responsible for processing medical bills for various ancillary healthcare services by reviewing notes, claim forms, and authorizations to ensure alignment with diagnosis and provider recommendations. This involves applying strong data-entry skills to guarantee accurate and timely submission for provider payments and client invoicing.
The Telephonic Case Manager coordinates resources and develops cost-effective, personalized care plans for ill or injured individuals, aiming to support quality treatment and timely return to work. This involves assessing treatment plan appropriateness using clinical expertise and communicating directly with treating physicians to evaluate and recommend alternative care options.
The Intake Specialist provides administrative customer service by receiving and entering new ancillary healthcare referrals via telephonic and written communication. They must maintain a high focus on accuracy and urgency to quickly process service orders aligned with customer needs.
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