Claim Processor Jobs in Claiborne, LA

Essential Job Functions and Responsibilities Investigates and maintains claims: Reviews and evaluates coverage and/or liability. Secures and analyzes necessary information (i.e., reports, policies, appraisals, releases, statements, records or other documents) in the investigation of claims. Works toward the resolution of claims files, and may attend arbitrations, mediations, depositions or trials as necessary. May affect settlements/reserves within prescribed limits and submit recommendations to supervisor on cases exceeding personal authority. Conveys simple to moderately complex information (coverage, decision, outcomes, etc.) to all appropriate parties, maintaining a professional demeanor in all situations. Ensures that claims payments are issued in a timely and accurate manner. Ensures that claims handling is conducted in compliance with applicable statues, regulations and other legal requirements, and that all applicable company procedures and policies are followed. Performs other duties as assigned. Job Requirements Education: Bachelor's Degree or equivalent experience. Field of Study: Liberal Arts, Business or a related discipline. Experience: Generally, 6 months to 3 years of related experience. Workers Compensation license required Texas experience preferred but not required

+ **** + **** **Claims Examiner-Other General Services Savoy-PRN in Mamou, LA** ** Job Description | Apply Now** The Claims Examiner is responsible for processing UB and CMS 1500 claims, performing data entry and claim pend issue resolution within the quality and production requirements. **Requirements:** * High School Diploma **Work Schedule:** TBD **Work Type:** Per Diem As Needed **EEO is the law - click below for more information:** We endeavor to make this site accessible to any and all users. If you would like to contact us regarding the accessibility of our website or need assistance completing the application process, please contact us at **************. to apply **Job Attributes** **Job ID** 233900 **Job Title** Claims Examiner-Other General Services Savoy-PRN **Job Type** PRN **Job Category** General Operations **Location** CHRISTUS St. Frances Cabrini Health System 801 Poinciana Avenue Mamou, LA 70554 **Share this job on** **Claims Examiner-Other General Services Savoy-PRN** **This jobs functionality is being updated, please use the page and filter by location.**

The position is located in the CIS Business Office and reports directly to the Insurance Claims Team Leader and Director of Business Services for all matters, including job duties, performance evaluations, approval of leave, and other assignments as deemed necessary by CIS management. NATURE OF DUTIES: Works in the billing office as an Insurance Claims Specialist. SPECIFIC DUTIES: 1. Work Insurance collections accounts as received, correcting and refilling claims as needed, or posting the necessary adjustments daily. 2. Work mail including refund requests, extensions, and requests for additional information daily. 3. Keep current on Insurance, Managed Care, and other changes including CPT and ICD coding, global, and CCI guidelines by reading provider newsletters, talking to provider representatives, etc. 4. Answer patient questions concerning insurance or billing issues. 5. Work follow-ups on a regular basis. 6. Prepare and work outstanding reports. 7. Prepare and work credit balance report. 8. Maintain log of audits, including pre-payment audits. 9. Performs other related duties as assigned and serves in whatever other capacity deemed necessary for successful completion of the mission and goals of CIS and in concordance with its patient philosophy. STANDARDS OF PERFORMANCE: 1. Maintain acceptable A/R levels for Private Insurance (Under 75 days in A/R). 2. Maintain proper documentation (as outlined in the denial tracking handout) and keep follow-ups current. 3. Keeps work area neat and organized. 4. Helping fellow employees when all duties are complete 5. Communicate any problems or difficulties concerning job duties as they arise to supervisor. 6. Meets all deadlines and timeframes for completion of assignments. 7. Performs all duties without significant error occurring with any regularity. 8. Represents CIS in a professional manner at all times. 9. Exhibits at all times good communication skills with physicians, patients, supervisors, and co-workers. 10. Exhibits whenever possible a harmonious relationship with other CIS employees in order to accomplish the duties and responsibilities of the position. While perfect harmonious relationships with all employees is sometimes not achievable, not more than an occasional complaint should be received by the supervisor about the incumbent of this position. 11. Adheres to the CIS Compliance Plan as it pertains to the above specific job duties. Uses best efforts to maintain compliance by following the CIS Corporate Compliance Plan, attending CIS compliance education, following medical documentation guidelines, and communicating concerns regarding compliance issues. QUALIFICATIONS FOR THE POSITION: 1. High School graduate preferred 2. Demonstrated ability to organize 3. Possess time management skills 4. Ability to understand and use a computer system 5. Experience with telephone collections preferred, but not required.

Snaggle Dental West Monroe, LA 71291 Job details Salary: Starting from $16.00-$20.00/hourly Pay is based on experience and qualifications. **incentives after training vary and are based on performance Job Type: Full-time Full Job Description With our hearts, minds, and hands, we build better smiles, better relationships, and better lives. Living this purpose over the last 25 years has allowed us to create a world-class dental organization that continues to grow. At every turn, you will see our continued investment in leadership, the community, and advanced technologies. Do you want to be a part of developing one of the leading models of dental care in Louisiana? Do you thrive in a fast-paced, progressive environment? The role of the Insurance Claims Specialist could be for you! Please go to WWW.PEACHTREEDENTAL.COM to complete your online application and assessments or use the following URL: ********************************************** Qualifications High school or equivalent (Required) Takes initiative. Has excellent verbal and written skills. Ability to manage all public dealings in a professional manner. Ability to recognize problems and problem solve. Ability to accept feedback and willingness to improve. Ability to set goals, create plans, and convert plans into action. Is a Brand ambassador, both in and outside of the facility. Benefits offered for Full-time Insurance Claims Specialists: Medical, Dental, Vision Benefits Dependent Care & Healthcare Flexible Spending Account Simple IRA With Employer Match Basic Life, AD&D & Supplemental Life Insurance Short-term & Long-term Disability Perks & Rewards for Full-time Insurance Claims Specialists: Competitive pay + bonus Paid Time Off & Sick time 6 paid Holidays a year

Administers and resolves non-complex short term claims of low monetary amounts, including medical only claims. Documents and monitors open case inventory and ensures proper and timely closing of files. Makes decisions on claims within delegated limited authority. Responsibilities Conducts investigations of claims to confirm coverage and to determine liability, compensability, and damages. Works closely with claimants, witnesses and members of the medical profession and other persons pertinent to the investigation and processing of claims. Verifies policy coverage for submitted claims and notifies the insured of any issues; determines and establishes reserve requirements, adjusting reserves, as necessary, during the processing of the claim. Identifies wage loss expenses and wage exposures on medical claims. Documents receipt and contents of medical reports. Interacts frequently with claimant to understand nature and extent of injury and medical conditions. Reviews and handles other correspondence within authority including material from the team members, and/or clients. Approves payments of medical bills on lost time disability claims within area of payment authority up to, but not exceeding, $2,500 after compensability has been determined. Evaluates medical claims for potential fraud issues, loss control and recovery in accordance with insurance policy contracts, medical bill coding rules and state regulations. Keeps Team Manager informed verbally and in writing of activities and problems within assigned area of responsibility; refers matters beyond limits of authority and expertise to Team Manager for direction. With the team managers guidance, provides input on the completion of status reports, initiate's activity checks and/or widow's statement of dependency forms. Completes all reporting forms and file documentation. Adheres to client and carrier guidelines and prepares written updates for supervisor to review. Performs other related duties as required or requested. Requirements College degree or the equivalent of education and experience. Knowledge of claims and familiarity with claims terminology gained through industry experience and/or through specialized courses of study (Associate in Claim designation, etc). Must have or secure and maintain the appropriate license(s) as required by the state(s) at the adjuster/supervisory/management level. Demonstrates a thorough working knowledge of claim processing and claim policies and procedures. Demonstrates an understanding of basic medical terminology and appropriate medical tests for claimed conditions Demonstrates effective and diplomatic oral and written communication skills. Demonstrates a customer-focused approach including the ability to identify and understand customer needs, and interacts effectively with others. About Us Why Crawford? Because a claim is more than a number - it's a person, a child, a friend. It's anyone who looks to Crawford on their worst days. And by helping to restore their lives, we are helping to restore our community - one claim at a time. At Crawford, employees are empowered to grow, emboldened to act and inspired to innovate. Our industry-leading team pioneers new solutions for the industries and customers we serve. We're looking for the next generation of leaders to take this journey with us. We hail from more than 70 countries and speak dozens of languages, reflecting the global fabric of the audience we serve. Though our reach is vast, we proudly operate as One Crawford: united in purpose, vision and values. Learn more at *************** When you accept a job with Crawford, you become a part of the One Crawford family. Our total compensation plans provide each of our employees with far more than just a great salary Pay and incentive plans that recognize performance excellence Benefit programs that empower financial, physical, and mental wellness Training programs that promote continuous learning and career progression while enhancing job performance Sustainability programs that give back to the communities in which we live and work A culture of respect, collaboration, entrepreneurial spirit and inclusion Crawford & Company participates in E-Verify and is an Equal Opportunity Employer. M/F/D/V Crawford & Company is not accepting unsolicited assistance from search firms for this employment opportunity. All resumes submitted by search firms to any employee at Crawford via-email, the Internet or in any form and/or method without a valid written Statement of Work in place for this position from Crawford HR/Recruitment will be deemed the sole property of Crawford. No fee will be paid in the event the candidate is hired by Crawford as a result of the referral or through other means.

Company:Marsh McLennan AgencyDescription: As a Claims Specialist for the Marsh McLennan Agency, you will be a claims consultant providing oversight and advocacy on behalf of our clients throughout the process of a loss event and the life of a claim. This position is client facing and requires single-day regional travel to our client locations. Duties include: You will submit claims or provide guidance on claim submission; Compiles Risk Services Plans (RSPs); Monitors RSPs to ensure we are delivering all services as promised; Review coverages and resolve claims issues; Compiles & delivers Stewardship Reports to clients; Compiles e-mod forecasts & delivers e-mod analytical reports; Assists clients in finding solutions for problematic modifiers; Reports claims to insurance carriers, assisting in the communication between clients and adjusters; Ensure carrier commitments are honored; Coordinate and participate in scheduled claims reviews; Serve as your client's advocate with adjusters and their coverage counsel; Resolve coverage disputes whenever possible; Assess and strategize to produce best possible claim outcomes; Duties may also include: Review of client's overall claims program and individual complex claims situations; On-site visit when a catastrophic loss occurs; Completes Open Claims Reviews Develop strategic action plans to reach desired outcomes; Provide guidance regarding potential large settlements; Recommend suitable vendor partners, including claims TPAs, nurse triage, and others; Review adjuster's claim action plans; facilitate claims resolutions; Evaluate insurance company claim reserves and push for reductions where appropriate; REQUIREMENTS: High School Diploma, Bachelor's degree preferred; Adjusters license; Knowledge of accepted industry standards and practices; Ability to think critically, solve problems, plan and organize activities, serve clients, negotiate, effectively communicate verbally and in writing and embrace new challenges; Analytical skill necessary to make decisions and resolve issues inherent in handling of claims; We embrace a culture that celebrates and promotes the many backgrounds, heritages and perspectives of our colleagues and clients. Marsh & McLennan Agency offers competitive salaries and comprehensive benefits and programs including: health and welfare, tuition assistance, 401K, employee assistance program, career mobility, employee network groups, volunteer opportunities, and other programs. For more information about our company, please visit us at: *************************** . #MMASW #LI-AK1

Taking care of people is at the heart of everything we do, and we start by taking care of you, our valued colleague. A career at Sedgwick means experiencing our culture of caring. It means having flexibility and time for all the things that are important to you. It's an opportunity to do something meaningful, each and every day. It's having support for your mental, physical, financial and professional needs. It means sharpening your skills and growing your career. And it means working in an environment that celebrates diversity and is fair and inclusive. A career at Sedgwick is where passion meets purpose to make a positive impact on the world through the people and organizations we serve. If you are someone who is driven to make a difference, who enjoys a challenge and above all, if you're someone who cares, there's a place for you here. Join us and contribute to Sedgwick being a great place to work. Great Place to Work Most Loved Workplace Forbes Best-in-State Employer Claims Specialist, Professional Liability **ESSENTIAL FUNCTIONS and RESPONSIBILITIES** + Analyzes and processes complex or technically difficult liability claims by investigating and gathering information to determine the exposure on the claim; manages claims through well-developed action plans to an appropriate and timely resolution. + Conducts or assigns full investigation and provides report of investigation pertaining to new events, claims and legal actions. + Negotiates claim settlement up to designated authority level. + Calculates and assigns timely and appropriate reserves to claims; monitors reserve adequacy throughout claim life. + Recommends settlement strategies; brings structured settlement proposals as necessary to maximize settlement. + Performs coverage analysis and opinion as part of the claim process including all necessary correspondence. + Coordinates legal defense by assigning attorney, coordinating support for investigation, and reviewing attorney invoices; monitors counsel for compliance with client guidelines. + Uses appropriate cost containment techniques including strategic vendor partnerships to reduce overall claim cost for our clients. + Identifies and investigates for possible fraud, subrogation, contribution, recovery, and case management opportunities to reduce total claim cost. + Represents company in depositions, mediations, and trial monitoring as needed. + Communicates claim activity and processing with the client; maintains professional client relationships. + Ensures claim files are properly documented and claims coding is correct. + Refers cases as appropriate to supervisor and management. + Delegates work and mentors others. **ADDITIONAL FUNCTIONS and RESPONSIBILITIES** + Performs other duties as assigned. + Travels as required. **QUALIFICATIONS** **Education & Licensing** Masters or Juris Doctorate degree from an accredited college or university preferred. Licenses as required. Designations and/or licensing including but not limited to Bachelor of Science in Nursing, Legal Nurse Consultant, Associate in Claims (AIC), Chartered Property and Casualty Underwriter (CPCU), Associate in Risk Management (ARM), Associate in Insurance Claims (AIC), Certified Professional in Health Care Risk Management (CPHRM) preferred. **Experience** Ten (10) years of complex claims management experience or equivalent combination of education and experience required. **Skills & Knowledge** + In-depth knowledge of appropriate medical malpractice insurance principles and laws for line-of-business handled, recoveries offsets and deductions, claim and disability duration, cost containment principles including medical management practices and Social Security application procedures as applicable to line-of-business + Extensive knowledge and comprehension of insurance coverage + Claims expertise in medical malpractice, errors and omissions, directors and officers, life sciences, and/or cyber liability + Excellent oral and written communication, including presentation skills + PC literate, including Microsoft Office products + Analytical and interpretive skills + Strong organizational skills + Excellent negotiation skills + Good interpersonal skills + Ability to work in a team environment + Ability to meet or exceed Performance Competencies **WORK ENVIRONMENT** When applicable and appropriate, consideration will be given to reasonable accommodations. **Mental** **:** Clear and conceptual thinking ability; excellent judgment, troubleshooting, problem solving, analysis, and discretion; ability to handle work-related stress; ability to handle multiple priorities simultaneously; and ability to meet deadlines **Physical** **:** Computer keyboarding, travel as required **Auditory/Visual** **:** Hearing, vision and talking _As required by law, Sedgwick provides a reasonable range of compensation for roles that may be hired in jurisdictions requiring pay transparency in job postings. Actual compensation is influenced by a wide range of factors including but not limited to skill set, level of experience, and cost of specific location. For the jurisdiction noted in this job posting only, the range of starting pay for this role is_ **_$115,000- $120,000_** _. A comprehensive benefits package is offered including but not limited to, medical, dental, vision, 401k and matching, PTO, disability and life insurance, employee assistance, flexible spending or health savings account, and other additional voluntary benefits._ The statements contained in this document are intended to describe the general nature and level of work being performed by a colleague assigned to this description. They are not intended to constitute a comprehensive list of functions, duties, or local variances. Management retains the discretion to add or to change the duties of the position at any time. Sedgwick is an Equal Opportunity Employer and a Drug-Free Workplace. **If you're excited about this role but your experience doesn't align perfectly with every qualification in the job description, consider applying for it anyway! Sedgwick is building a diverse, equitable, and inclusive workplace and recognizes that each person possesses a unique combination of skills, knowledge, and experience. You may be just the right candidate for this or other roles.** **Taking care of people is at the heart of everything we do. Caring counts** Sedgwick is a leading global provider of technology-enabled risk, benefits and integrated business solutions. Every day, in every time zone, the most well-known and respected organizations place their trust in us to help their employees regain health and productivity, guide their consumers through the claims process, protect their brand and minimize business interruptions. Our more than 30,000 colleagues across 80 countries embrace our shared purpose and values as they demonstrate what it means to work for an organization committed to doing the right thing - one where caring counts. Watch this video to learn more about us. (************************************** BGSfA)

Claim Clerk Hours: Monday - Friday, 8:00 AM to 4:30 PM Employment Type: Hourly Salary Range: $15/hr - $17/hr Disclaimer: The posted salary range for this position reflects the anticipated base pay for this role. Actual pay is determined based on factors such as qualifications, skills, relevant experience, internal equity, and location. Additional compensation may include discretionary bonuses, benefits, or other forms of compensation, depending on the role. The salary range provided is in compliance with state and local requirements and is intended to offer transparency to applicants. We encourage open discussions with our hiring team regarding any questions you may have about compensation and benefits for this position. CCMSI is an Affirmative Action / Equal Employment Opportunity employer offering an excellent benefits package including Medical, Dental, Prescription Drug, Vision, Flexible Spending, Life, ESOP, and 401K. About CCMSI: At CCMSI, we are dedicated to delivering exceptional service and solutions to our clients. We pride ourselves on creating a positive, collaborative, and flexible workplace where our employees can thrive and grow. Join our team to make a difference and contribute to our success. Joining CCMSI means becoming part of a workplace where employees are valued, supported, and set up for success every day. Position Overview: The Claims Assistant provides general clerical support to claim personnel and team members. This role is essential in maintaining high-quality claim service in line with CCMSI's Corporate Claim Standards. The Claims Assistant will be expected to handle various administrative tasks, assist claim staff, and contribute to our commitment to client service. Responsibilities This position requires a commitment to providing quality service that aligns with CCMSI's Corporate Claim Standards and client expectations. Mail Handling & Filing: Match incoming mail for assigned accounts, file claim documents, and maintain organized claim files. File Set-Up & Organization: Set up and complete instructions for designated claim files and maintain claim files in storage. Billing & Correspondence: Follow up on outstanding bills, summarize correspondence and medical records in claim log notes, and organize documentation as needed. Phone & Reception Duties: Act as a back-up for the receptionist, handle calls from providers and others as directed, and support client-specific claim teams. General Office Support: Photocopy claim documents, retrieve and re-file closed files, and ensure compliance with team service commitments. Team Collaboration: Work closely with claim staff to provide support and ensure a seamless service experience for clients. Qualifications Education: High school diploma or equivalent. Skills: Excellent verbal and written communication skills. Strong organizational abilities and attention to detail. Ability to operate general office equipment and perform clerical duties with minimal supervision. Flexibility, initiative, and discretion are essential. Technical Proficiency: Proficient in Microsoft Office programs. Work Environment: Must exhibit reliable, predictable attendance and responsiveness to internal and external client needs. Physical Requirements: Lifting Requirements: Medium Lifting: Ability to lift objects weighing 15-35 pounds regularly. Heavy Lifting: Occasionally lift objects weighing 35-50 pounds (team lifts and mechanical assistance should be used as needed). Other Physical Demands: Ability to sit or stand for extended periods. Manual dexterity, auditory, and visual acuity are required to interact with others. No requirement for color vision. Core Values & Principles: Employees are expected to uphold CCMSI's Core Values and Principles, which include performing with integrity; passionately focus on client service; embracing a client-centered vision; maintaining contagious enthusiasm for our clients; searching for the best ideas; looking upon change as an opportunity; insisting upon excellence; creating an atmosphere of excitement, informality and trust; focusing on the situation, issue, or behavior, not the person; maintaining the self-confidence and self-esteem of others; maintaining constructive relationships; taking the initiative to make things better; and leading by example. Why Join CCMSI? We offer a collaborative work environment with opportunities for growth, learning, and career advancement. Be part of a team that values service excellence and fosters a supportive atmosphere. Apply today to contribute to our success and begin your rewarding career with CCMSI! #CCMSIMetairie #Hiring #JobOpening #ClaimClerk #MetairieLA #InOfficeJob #AdminSupport #CCMSICareers #JoinOurTeam #EmployeeOwned #GreatPlaceToWork #CareerGrowth #IND456 We can recommend jobs specifically for you! Click here to get started.

The Oncology Claims Analyst 1 will coordinate coding audits and educational functions for FMOLHS and the Oncology Service Line. This individual will be responsible for drug authorizations, managing and working the edit and denial coding work queues for inpatient, outpatient clinic, and hospital based infusion departments and will provide coding and reimbursement feedback for education opportunities identified to the Service Line and FMOLHS. Prepares and presents coding education to providers and works in collaboration with various hospital and FMOLHS departments as a liaison related to NCCN, ASCO, and FDA guidelines. Must be familiar with reviewing documentation to assign appropriate CPT/HCPCS and ICD-10-CM-PCS diagnosis codes, understand current professional coder workflows, reviews principal, secondary diagnoses and procedures for hospital and physician (professional) services for inpatient, outpatient, and infusion records based on knowledge of coding systems. Additionally serves as business/reimbursement specialist for oncology drug regimens for both the Service Line and FMOLHS. **Responsibilities** - **Coding/Program Management** * Reviews and audits codes (CPT, ICD 10, HCPC, Level II, and modifier coding, etc.) and is expert on prior authorization using FDA, National Comprehensive Cancer Network (NCCN), and American Society of Clinical Oncology (ASCO) for specialty practices like inpatient chemotherapy hospitalizations, outpatient oncology visits, hospital based outpatient infusion centers for both oncology and non-oncology patients. * Is consultant/expert for FMOLHS business office and external agencies in clarification of coding regarding reimbursement infusion issues, especially new FDA and new clinical pathways of National Comprehensive Cancer Network (NCCN). Manages data gathering and chart auditing as necessary for FMOLHS Revenue Cycle, LPG, and Oncology Service Line. * Works closely and consistently with major pharmaceutical companies on new drug treatment guidelines/pathways, drug replacement programs, and Southern Oncology Association of Practices (SOAP) to determine business best practices and clinical education opportunities for physicians/providers. Reports findings consistently to Director of Pharmacy and VP of Oncology Service Line. * Advises the executive team on best practices for drug purchase opportunities to ensure potential profitability is maximized while working with FMOLHS contract director to verify profitability of managed care contracts related to drug margins. * Works with various national oncology specific institutions, like MD Anderson, Bone Marrow transplant centers, etc. alongside physicians/payers directly whether clinical pathways/treatment regimens fall within proper coding/maximum reimbursement of clinical trials, off label, NCCN guideline, etc. to manage proper clean claims and decrease likelihood of claim denial. * Works directly with business, administrative team, and physicians/providers to perform at least monthly education on chart audits, new treatment pathways, governmental payer requirements, and others. - **Coding/Program Management** * Reviews and audits codes (CPT, ICD 10, HCPC, Level II, and modifier coding, etc.) and is expert on prior authorization using FDA, National Comprehensive Cancer Network (NCCN), and American Society of Clinical Oncology (ASCO) for specialty practices like inpatient chemotherapy hospitalizations, outpatient oncology visits, hospital based outpatient infusion centers for both oncology and non-oncology patients. * Is consultant/expert for FMOLHS business office and external agencies in clarification of coding regarding reimbursement infusion issues, especially new FDA and new clinical pathways of National Comprehensive Cancer Network (NCCN). Manages data gathering and chart auditing as necessary for FMOLHS Revenue Cycle, LPG, and Oncology Service Line. * Works closely and consistently with major pharmaceutical companies on new drug treatment guidelines/pathways, drug replacement programs, and Southern Oncology Association of Practices (SOAP) to determine business best practices and clinical education opportunities for physicians/providers. Reports findings consistently to Director of Pharmacy and VP of Oncology Service Line. * Advises the executive team on best practices for drug purchase opportunities to ensure potential profitability is maximized while working with FMOLHS contract director to verify profitability of managed care contracts related to drug margins. * Works with various national oncology specific institutions, like MD Anderson, Bone Marrow transplant centers, etc. alongside physicians/payers directly whether clinical pathways/treatment regimens fall within proper coding/maximum reimbursement of clinical trials, off label, NCCN guideline, etc. to manage proper clean claims and decrease likelihood of claim denial. * Works directly with business, administrative team, and physicians/providers to perform at least monthly education on chart audits, new treatment pathways, governmental payer requirements, and others. - **Analysis and Collaboration** * Proactively researches and understands payer issues. Troubleshoots and resolves issues that impact revenue. Works collectively with FMOLHS denial management team to audit Medicare, Medicaid, and Insurance claims for accurate coding, charging, and modifier usage as requested by the FMOLHS. Considered expert for high dollar drug appeals across FMOLHS. * Considered expert for the Physician Group, Revenue Management Department, Pharmacy, and other financial departments in clarification of coding regarding reimbursement issues to resolve claim edits and assure clean claim submission. Monitors and evaluates compliance with documentation standards to identify trends, issues, risk areas, and opportunities for performance improvement. * Continually analyzes reports/margin analyzers to communicate business performance to the administrative team, revenue cycle team, physician practice managers, and physicians to determine efficacy and suggests opportunities for improvement. * Acts as a liaison for Professional Billing and FMOLHS Central Billing Office Management assisting in any special requests/research for information/proper documentation to aid in billing processes especially high dollar denials/write offs/analysis. **Qualifications** * Experience: 3 years of medical revenue cycle experience * Education: High School Diploma

The Oncology Claims Analyst 1 will coordinate coding audits and educational functions for FMOLHS and the Oncology Service Line. This individual will be responsible for drug authorizations, managing and working the edit and denial coding work queues for inpatient, outpatient clinic, and hospital based infusion departments and will provide coding and reimbursement feedback for education opportunities identified to the Service Line and FMOLHS. Prepares and presents coding education to providers and works in collaboration with various hospital and FMOLHS departments as a liaison related to NCCN, ASCO, and FDA guidelines. Must be familiar with reviewing documentation to assign appropriate CPT/HCPCS and ICD-10-CM-PCS diagnosis codes, understand current professional coder workflows, reviews principal, secondary diagnoses and procedures for hospital and physician (professional) services for inpatient, outpatient, and infusion records based on knowledge of coding systems. Additionally serves as business/reimbursement specialist for oncology drug regimens for both the Service Line and FMOLHS. Responsibilities Coding/Program Management Reviews and audits codes (CPT, ICD 10, HCPC, Level II, and modifier coding, etc.) and is expert on prior authorization using FDA, National Comprehensive Cancer Network (NCCN), and American Society of Clinical Oncology (ASCO) for specialty practices like inpatient chemotherapy hospitalizations, outpatient oncology visits, hospital based outpatient infusion centers for both oncology and non-oncology patients. Is consultant/expert for FMOLHS business office and external agencies in clarification of coding regarding reimbursement infusion issues, especially new FDA and new clinical pathways of National Comprehensive Cancer Network (NCCN). Manages data gathering and chart auditing as necessary for FMOLHS Revenue Cycle, LPG, and Oncology Service Line. Works closely and consistently with major pharmaceutical companies on new drug treatment guidelines/pathways, drug replacement programs, and Southern Oncology Association of Practices (SOAP) to determine business best practices and clinical education opportunities for physicians/providers. Reports findings consistently to Director of Pharmacy and VP of Oncology Service Line. Advises the executive team on best practices for drug purchase opportunities to ensure potential profitability is maximized while working with FMOLHS contract director to verify profitability of managed care contracts related to drug margins. Works with various national oncology specific institutions, like MD Anderson, Bone Marrow transplant centers, etc. alongside physicians/payers directly whether clinical pathways/treatment regimens fall within proper coding/maximum reimbursement of clinical trials, off label, NCCN guideline, etc. to manage proper clean claims and decrease likelihood of claim denial. Works directly with business, administrative team, and physicians/providers to perform at least monthly education on chart audits, new treatment pathways, governmental payer requirements, and others. Coding/Program Management Reviews and audits codes (CPT, ICD 10, HCPC, Level II, and modifier coding, etc.) and is expert on prior authorization using FDA, National Comprehensive Cancer Network (NCCN), and American Society of Clinical Oncology (ASCO) for specialty practices like inpatient chemotherapy hospitalizations, outpatient oncology visits, hospital based outpatient infusion centers for both oncology and non-oncology patients. Is consultant/expert for FMOLHS business office and external agencies in clarification of coding regarding reimbursement infusion issues, especially new FDA and new clinical pathways of National Comprehensive Cancer Network (NCCN). Manages data gathering and chart auditing as necessary for FMOLHS Revenue Cycle, LPG, and Oncology Service Line. Works closely and consistently with major pharmaceutical companies on new drug treatment guidelines/pathways, drug replacement programs, and Southern Oncology Association of Practices (SOAP) to determine business best practices and clinical education opportunities for physicians/providers. Reports findings consistently to Director of Pharmacy and VP of Oncology Service Line. Advises the executive team on best practices for drug purchase opportunities to ensure potential profitability is maximized while working with FMOLHS contract director to verify profitability of managed care contracts related to drug margins. Works with various national oncology specific institutions, like MD Anderson, Bone Marrow transplant centers, etc. alongside physicians/payers directly whether clinical pathways/treatment regimens fall within proper coding/maximum reimbursement of clinical trials, off label, NCCN guideline, etc. to manage proper clean claims and decrease likelihood of claim denial. Works directly with business, administrative team, and physicians/providers to perform at least monthly education on chart audits, new treatment pathways, governmental payer requirements, and others. Analysis and Collaboration Proactively researches and understands payer issues. Troubleshoots and resolves issues that impact revenue. Works collectively with FMOLHS denial management team to audit Medicare, Medicaid, and Insurance claims for accurate coding, charging, and modifier usage as requested by the FMOLHS. Considered expert for high dollar drug appeals across FMOLHS. Considered expert for the Physician Group, Revenue Management Department, Pharmacy, and other financial departments in clarification of coding regarding reimbursement issues to resolve claim edits and assure clean claim submission. Monitors and evaluates compliance with documentation standards to identify trends, issues, risk areas, and opportunities for performance improvement. Continually analyzes reports/margin analyzers to communicate business performance to the administrative team, revenue cycle team, physician practice managers, and physicians to determine efficacy and suggests opportunities for improvement. Acts as a liaison for Professional Billing and FMOLHS Central Billing Office Management assisting in any special requests/research for information/proper documentation to aid in billing processes especially high dollar denials/write offs/analysis. Qualifications Experience: 3 years of medical revenue cycle experience Education: High School Diploma

Trustmark's mission is to improve wellbeing - for everyone. It is a mission grounded in a belief in equality and born from our caring culture. It is a culture we can only realize by building trust. Trust established by ensuring associates feel respected, valued and heard. At Trustmark, you'll work collaboratively to transform lives and help people, communities and businesses thrive. Flourish in a culture of diversity and inclusion where appreciation, mutual respect and trust are constants, not just for our customers but for ourselves. At Trustmark, we have a commitment to welcoming people, no matter their background, identity or experience, to a workplace where they feel safe being their whole, authentic selves. A workplace made up of diverse, empowered individuals that allows ideas to thrive and enables us to bring the best to our colleagues, clients and communities. Responsible for reviewing and processing claims including, identifying irregularities and reviewing for accuracy, and completeness. Must comply with policy provisions and appropriate state and federal laws. Claim types include Wellness, Hospital Indemnity, Accident, Life, Long-Term Care (LTC), Disability and Critical Care. **Key Accounabilities:** Demonstrates strong understanding and performs claims handling processes and procedures related to Wellness, Hospital and Accident claims.Manages high volume of non-routine claims and phone calls.Explains more complex contract definitions to insureds both verbally and in writing.Processes claim operational activities which may include tax reporting, journal vouchers, overpayments or special investigation duties. Reviews and understands non-routine medical records. **Minimum Requirements:** High School Diploma or GED with 4 - 6 years of related experience. Brand: Trustmark Come join a team at Trustmark that will not only utilize your current skills but will enhance them as well. **For the fourth consecutive year we were selected as a Top Workplace by the Chicago Tribune.** The award is based exclusively on Trustmark associate responses to an anonymous survey. The survey measured 15 key drivers of engaged cultures that are critical to the success of an organization. All qualified applicants will receive consideration for employment without regard to race, religion, color, national origin, sex, sexual orientation, sexual identity, age, veteran or disability. Join a passionate and purpose-driven team of colleagues who contribute to Trustmark's mission of helping people increase wellbeing through better health and greater financial security. At Trustmark, you'll work collaboratively to transform lives and help people, communities and businesses thrive. Flourish in a culture where appreciation, mutual respect and trust are constants, not just for our customers but for ourselves. Introduce yourself to our recruiters and we'll get in touch if there's a role that seems like a good match. When you join Trustmark, you become part of an organization that makes a positive difference in people's lives. You will play a vital role in delivering on our mission of helping people increase wellbeing through better health and greater financial security. Our customers tell us they simply appreciate the personal attention and knowledgeable service. Others tell us we've changed their lives. At Trustmark, you'll be part of a close-knit team. You'll enjoy abundant opportunities to grow your career. That's why so many of our associates stay at Trustmark and thrive. Trustmark benefits from more than 100 years of experience but pairs that rich history with a palpable sense of optimism, growth and excitement for what's ahead - and beyond. This is a place where associates bring their whole selves to work each day. A place where you can be yourself. Whatever your beyond is, you can achieve it at Trustmark.

Purpose/Job Function: The claims associate will support the filing, tracking, and management of claims for all modes supporting a MTS customer. This role will include working closely with the customer at both corporate offices as well as in the field. There will also be frequent communications with carriers to collect documentation as well as status updates. The data collection and analysis produced in this role will be critical in driving continuous improvements to the customer's service performance. Essential Functions: File and manage LTL and Parcel freight claims including freight, shortages, overages, and damages. Deliver reliable service throughout the entire life cycle of each claim, including but not limited to: prompt contact and timely communication throughout the process until the claim is closed, explaining the process, setting expectations, follow-ups and meeting commitments to achieve optimal outcome on every file. Assist with client and vendor damage claims. Develop and grow effective relationships with clients, vendors, and internal business partners. Update and maintain records Recognize and request appropriate inspection type based on the details of the loss and coordinate the appraisal process. Maintain oversight of the repair process and ensure appropriate expense handling, manage approvals per guidelines. Manage and report weekly review of LTL carrier complaints. Provide reports to support visibility to claims trends and opportunities to reduce issues. Run reports and data analysis as needed. Qualifications/Requirements: Excellent verbal and written communication in order to respond effectively to sensitive inquiries and complaints Strong data entry and record keeping skills (may include maintaining records in database/s) Ability to apply principles of logical thinking to a wide range of practical problems Strong organizational skills with accurate attention to detail Aptitude to spot trends in shipment data and detail Proficient in use of Microsoft Office Suite (use of Excel, Word, Outlook) Education/Experience: Highschool diploma or GED Prior data entry experience preferred #IND

Claims Representative (Hybrid) page is loaded **Claims Representative (Hybrid)** **Claims Representative (Hybrid)** remote type Hybrid locations Baton Rouge, LA (USA) time type Full time posted on Posted 30+ Days Ago job requisition id R6606 Headquartered in the Central Florida city of Lakeland, Summit employs over 700 office and field associates at its main location and regional offices in Baton Rouge, Louisiana, and Gainesville, Georgia. As the people who know workers' comp, we strive to provide an atmosphere of constant growth and development for our employees. Summit provides workers' compensation programs and services to thousands of employers throughout the Southeast. Summit is a member of Great American Insurance Group, a company that focuses on building relationships and linking people to various career paths. Whether it's underwriting, claims, accounting, IT, legal, or customer service, Great American Insurance Group combines a small-company entrepreneurial atmosphere with big- company expertise. **Essential Job Functions and Responsibilities** * Investigates and maintains claims: + Reviews and evaluates coverage and/or liability. + Secures and analyzes necessary information (i.e., reports, policies, appraisals, releases, statements, records or other documents) in the investigation of claims. * Works toward the resolution of claims files, and may attend arbitrations, mediations, depositions or trials as necessary. * May affect settlements/reserves within prescribed limits and submit recommendations to supervisor on cases exceeding personal authority. * Conveys simple to moderately complex information (coverage, decision, outcomes, etc.) to all appropriate parties, maintaining a professional demeanor in all situations. * Ensures that claims payments are issued in a timely and accurate manner. * Ensures that claims handling is conducted in compliance with applicable statues, regulations and other legal requirements, and that all applicable company procedures and policies are followed. * Performs other duties as assigned. **Job Requirements** **Education: Bachelor's Degree or equivalent experience.** **Field of Study: Liberal Arts, Business or a related discipline.** **Experience: Generally, 6 months to 3 years of related experience.** Workers Compensation license required Texas experience preferred but not required This job is non-exempt in California, Colorado, New York, Washington **Company:** SCI Summit Consulting, LLC**Benefits:** We offer competitive healthcare, retirement, and paid time off benefits for full-time and part-time benefit eligible employees. Headquartered in the Central Florida city of Lakeland, Summit employs over 700 office and field associates at its main location and regional offices in Baton Rouge, Louisiana, and Gainesville, Georgia. As the people who know workers' comp, we strive to provide an atmosphere of constant growth and development for our employees. With more than 40 years of experience, Summit provides workers' compensation programs and services to thousands of employers throughout the Southeast. Summit is a member of Great American Insurance Group, a company that focuses on building relationships and linking people to various career paths. Whether it's underwriting, claims, accounting, IT, legal, or customer service, Great American Insurance Group combines a small-company entrepreneurial atmosphere with big- company expertise.

Print (*********************************************************************** Apply Medical Certification Specialist 1-2 Salary $5,119.00 - $9,211.00 Monthly Job Type Classified Job Number OS/DRT/202926 Department LDH-Office of Secretary Opening Date 11/25/2024 Closing Date 12/2/2024 11:59 PM Central + Description + Benefits Supplemental Information The Louisiana Department of Health is dedicated to fulfilling its mission through direct provision of quality services, the development and stimulation of services of others, and the utilization of available resources in the most effective manner. LDH serves as a model employer for individuals with disabilities. This position is located within the Louisiana Department of Health / Office of the Secretary / Health Standards / Statewide Announcement Number: OS/DRT/202926 Cost Center: 3071040217 Position Number(s): 50652474 This vacancy is being announced as a Classified position and may be filled as a Probationary or Promotional appointment. Preference given to applicants with Registered Nurse licensure. Position may be filled within either of the following parishes: Caldwell, East Carroll, Franklin, Jackson, Lincoln, Madison Morehouse, Ouachita, Richland, Tensas, Union, & West Carroll. Frequent travel within these parishes will be required. No Civil Service test scoreis required in order to be considered for this vacancy. LDH/OS/Health Standards Section has a Special Entrance Rate (SER)for employees that are in possession of a valid Louisiana registered nurse license to practice professional nursing, a multi-state license issued by a Nursing Licensure Compact (NLC/eNLC) state, or a licensed physician (Doctor of Medicine). Medical Certification Specialist 1 - $36.56 hourly / $2,924.80 bi-weekly Medical Certification Specialist 2 - $39.12 hourly / $3,129.60 bi-weekly As part of a Career Progression Group, vacancies may be filled from this recruitment as a Medical Certification Specialist 1 or 2 depending on the level of experience of the selected applicant(s). The maximum salary for the Medical Certification Specialist 2 is $118,269. Please refer to the 'Job Specifications' tab located at the top of the LA Careers 'Current Job Opportunities' page of the Civil Service website for specific information on salary ranges, minimum qualifications and job concepts for each level. To apply for this vacancy, click on the "Apply" link above and complete an electronic application, which can be used for this vacancy as well as future job opportunities. Applicants are responsible for checking the status of their application to determine where they are in the recruitment process. Further status message information is located under the Information section of the Current Job Opportunities page. *Resumes WILL NOT be accepted in lieu of completed education and experience sections on your application. Applications may be rejected if incomplete.* A resume upload will NOTpopulate your information into your application. Work experience left off your electronic application or only included in an attached resume is not eligible to receive credit For further information about this vacancy contact: Deanda Thymes ******************** LDH/HUMAN RESOURCES BATON ROUGE, LA 70821 ************ This organization participates in E-Verify, and for more information on E-Verify, please contact DHS at **************. Minimum Qualifications MINIMUM QUALIFICATIONS: A baccalaureate degree plus two years of professional level experience in hospital or nursing home administration, public health administration, social services, nursing, pharmacy, dietetics/nutrition, physical therapy, occupational therapy, medical technology, or surveying and/or assessing health or social service programs or facilities for compliance with state and federal regulations. SUBSTITUTIONS: A current valid Louisiana license in one of the qualifying fields will substitute for the required baccalaureate degree. A master's degree in hospital administration, nursing home administration, public health administration, social work, nursing, pharmacy, dietetics, nutrition, physical therapy, occupational therapy, or medical technology will substitute for a maximum of one year of the required experience. NOTE: Any college hours or degree must be from an accredited college or university. NOTE: A current valid Louisiana license in an individual field may be required for some positions. Job Concepts FUNCTION OF WORK: To conduct surveys and/or assessments to verify that the services provided to individuals by providers, facilities, waivers, and/or long term care programs are in compliance with federal certification, state regulations, and established state standards. LEVEL OF WORK: Experienced. SUPERVISION RECEIVED: Broad review from Medical Certification Supervisor or other higher level agency administrator. SUPERVISION EXERCISED: None. LOCATION OF WORK: Department of Health and Hospitals. JOB DISTINCTIONS: Differs from Medical Certification Specialist 2 by the absence of Centers for Medicare and Medicaid Services certification and by the level of independence exercised in carrying out work responsibilities. Examples of Work EXAMPLES LISTED BELOW ARE BRIEF SAMPLES OF COMMON DUTIES ASSOCIATED WITH THIS JOB TITLE. PLEASE NOTE THAT NOT ALL TASKS ARE INCLUDED. Incumbent is located in the LDH/OS/Health Standards Section. This section is responsible for the licensing and certification of all healthcare programs located in the state. HSS currently licenses/certifies over 35 different healthcare provider types including over 8500 entities. These investigators require intense training and specialized certifications to achieve and maintain proficiency in determining compliance with the thousands of regulations that are inclusive of these programs. This compliance is required to ensure the health, safety and welfare of all citizens of this State who receive services in these licensed/certified healthcare facilities. The incumbent must have the knowledge, skills, abilities and training in the appropriate healthcare areas to ensure applicable standards of appropriate care are being followed. This requires a high level of critical thinking skills, autonomy and decision-making skills in addition to intense investigation skills to determine regulatory compliance. The ever-changing world of regulatory compliance requires that this incumbent be extremely dynamic with changing processes and a quick study to learn and apply these changing processes and interpretations. Failure to perform the duties in this position could adversely affect health related service delivery in the State and could result in millions of dollars in federal disallowance to the state and the interruption of health delivery to hundreds of thousands of consumers. 60% Conducts surveys with certified surveyor/surveyors on approximately 35 different health care providers/suppliers that operate in the State, this is done to determine conformity with state and federal regulations relative to licensure and certification which requires a broad knowledge of all state and federal program requirements. Conducts a facility review relative to organization, policies, and procedures, administration and quality of services to determine the extent of compliance with the state licensure standards and Medicare and Medicaid regulations, Obtains information from review of records, personnel interviews, resident interviews, and personal observations relative to the delivery of healthcare services and relative to the aspects of the operation of the facility and compliance standards. Compiles information derived from surveys, prepares reports on results of the surveys; describes findings as related to established program procedures and processes; determines conclusions based upon facts obtained, and formulates reports of these findings to enable the program desks to determine whether licensure or certification should be granted, denied, or altered depending upon established laws and regulations. When necessary, testifies in legal hearings relative to survey findings. Performs all surveys in a professional manner at all times, adheres to all assigned mandates, follows directions as given by supervisor, and assures accurate completion of duties in accordance with established state and federal guidelines and timelines, participates in an ongoing quality assurance program to ensure program integrity. 40% Conducts special investigations with certified surveyor/surveyors in response to complaints and prepares reports of findings. Interprets state and federal regulations to providers/suppliers as needed. Cooperates with administrators of facilities and professional groups in the preparation and presentation of education programs for healthcare providers and staff Participates in an ongoing quality assurance program to ensure program integrity. Louisiana State Government represents a wide variety of career options and offers an outstanding opportunity tomake a differencethrough public service. With an array of career opportunities in every major metropolitan center and in many rural areas, state employment provides an outstanding option to begin or continue your career. As a state employee, you will earn competitive pay, choose from a variety of benefits, and have access to a great professional development program: Insurance Coverage More information can be found at ******************************* Parental Leave- Up to six weeks paid parental leave More information can be found at****************************************************************** Holidays and Leave - State employees receive the following paid holidays each year: + New Year's Day + Martin Luther King, Jr. Day, + Mardi Gras, + Good Friday, + Memorial Day, + Independence Day, + Labor Day, + Veteran's Day, + Thanksgiving Day and Christmas Day. ***** Additional holidays may be proclaimed by the Governor State employees earn sick and annual leave which can be accumulated and saved for future use. Your accrual rate increases as your years of service increase. Retirement - State of Louisiana employees are eligible to participate in various retirement systems (based on the type of appointment and agency for which an employee works). These retirement systems provide retirement allowances and other benefits for state officers and employees and their beneficiaries. State retirement systems may include (but are not limited to): + Louisiana State Employees Retirement System (********************** LASERS has provided this video (********************************************************************************* to give you more detailed information about their system + Teacher's Retirement System of Louisiana (************** + Louisiana School Employees Retirement System (*************** among others Agency State of Louisiana Address For agency contact information, please refer to the supplemental information above. Louisiana State Civil Service, Louisiana, 70802 Phone ************** Website ****************************************************** Apply Please verify your email address Verify Email

The Oncology Claims Analyst 1 will coordinate coding audits and educational functions for FMOLHS and the Oncology Service Line. This individual will be responsible for drug authorizations, managing and working the edit and denial coding work queues for inpatient, outpatient clinic, and hospital based infusion departments and will provide coding and reimbursement feedback for education opportunities identified to the Service Line and FMOLHS. Prepares and presents coding education to providers and works in collaboration with various hospital and FMOLHS departments as a liaison related to NCCN, ASCO, and FDA guidelines. Must be familiar with reviewing documentation to assign appropriate CPT/HCPCS and ICD-10-CM-PCS diagnosis codes, understand current professional coder workflows, reviews principal, secondary diagnoses and procedures for hospital and physician (professional) services for inpatient, outpatient, and infusion records based on knowledge of coding systems. Additionally serves as business/reimbursement specialist for oncology drug regimens for both the Service Line and FMOLHS. * Coding/Program Management * Reviews and audits codes (CPT, ICD 10, HCPC, Level II, and modifier coding, etc.) and is expert on prior authorization using FDA, National Comprehensive Cancer Network (NCCN), and American Society of Clinical Oncology (ASCO) for specialty practices like inpatient chemotherapy hospitalizations, outpatient oncology visits, hospital based outpatient infusion centers for both oncology and non-oncology patients. * Is consultant/expert for FMOLHS business office and external agencies in clarification of coding regarding reimbursement infusion issues, especially new FDA and new clinical pathways of National Comprehensive Cancer Network (NCCN). Manages data gathering and chart auditing as necessary for FMOLHS Revenue Cycle, LPG, and Oncology Service Line. * Works closely and consistently with major pharmaceutical companies on new drug treatment guidelines/pathways, drug replacement programs, and Southern Oncology Association of Practices (SOAP) to determine business best practices and clinical education opportunities for physicians/providers. Reports findings consistently to Director of Pharmacy and VP of Oncology Service Line. * Advises the executive team on best practices for drug purchase opportunities to ensure potential profitability is maximized while working with FMOLHS contract director to verify profitability of managed care contracts related to drug margins. * Works with various national oncology specific institutions, like MD Anderson, Bone Marrow transplant centers, etc. alongside physicians/payers directly whether clinical pathways/treatment regimens fall within proper coding/maximum reimbursement of clinical trials, off label, NCCN guideline, etc. to manage proper clean claims and decrease likelihood of claim denial. * Works directly with business, administrative team, and physicians/providers to perform at least monthly education on chart audits, new treatment pathways, governmental payer requirements, and others. * Coding/Program Management * Reviews and audits codes (CPT, ICD 10, HCPC, Level II, and modifier coding, etc.) and is expert on prior authorization using FDA, National Comprehensive Cancer Network (NCCN), and American Society of Clinical Oncology (ASCO) for specialty practices like inpatient chemotherapy hospitalizations, outpatient oncology visits, hospital based outpatient infusion centers for both oncology and non-oncology patients. * Is consultant/expert for FMOLHS business office and external agencies in clarification of coding regarding reimbursement infusion issues, especially new FDA and new clinical pathways of National Comprehensive Cancer Network (NCCN). Manages data gathering and chart auditing as necessary for FMOLHS Revenue Cycle, LPG, and Oncology Service Line. * Works closely and consistently with major pharmaceutical companies on new drug treatment guidelines/pathways, drug replacement programs, and Southern Oncology Association of Practices (SOAP) to determine business best practices and clinical education opportunities for physicians/providers. Reports findings consistently to Director of Pharmacy and VP of Oncology Service Line. * Advises the executive team on best practices for drug purchase opportunities to ensure potential profitability is maximized while working with FMOLHS contract director to verify profitability of managed care contracts related to drug margins. * Works with various national oncology specific institutions, like MD Anderson, Bone Marrow transplant centers, etc. alongside physicians/payers directly whether clinical pathways/treatment regimens fall within proper coding/maximum reimbursement of clinical trials, off label, NCCN guideline, etc. to manage proper clean claims and decrease likelihood of claim denial. * Works directly with business, administrative team, and physicians/providers to perform at least monthly education on chart audits, new treatment pathways, governmental payer requirements, and others. * Analysis and Collaboration * Proactively researches and understands payer issues. Troubleshoots and resolves issues that impact revenue. Works collectively with FMOLHS denial management team to audit Medicare, Medicaid, and Insurance claims for accurate coding, charging, and modifier usage as requested by the FMOLHS. Considered expert for high dollar drug appeals across FMOLHS. * Considered expert for the Physician Group, Revenue Management Department, Pharmacy, and other financial departments in clarification of coding regarding reimbursement issues to resolve claim edits and assure clean claim submission. Monitors and evaluates compliance with documentation standards to identify trends, issues, risk areas, and opportunities for performance improvement. * Continually analyzes reports/margin analyzers to communicate business performance to the administrative team, revenue cycle team, physician practice managers, and physicians to determine efficacy and suggests opportunities for improvement. * Acts as a liaison for Professional Billing and FMOLHS Central Billing Office Management assisting in any special requests/research for information/proper documentation to aid in billing processes especially high dollar denials/write offs/analysis. * Experience: 3 years of medical revenue cycle experience * Education: High School Diploma

- Responsibilities/Duties/Functions/Tasks The purpose of this position is to work with clients to collect and verify employment and financial data to complete mortgage loan applications. · Contacts applicants by telephone e-mail or in-person meetings to gather financial information, including employment situation, salary, assets, financial status, current debts, and current expenses · Orders appraisal and title and assists in loan application completion · Receives data needed to verify employment length, financial statement accuracy, and collateral asset values · Clears underwriting conditions and reviews closing conditions · Submits application and conditions to the underwriter · Contacts and communicates with loan officers, closers, and underwriters to complete mortgage transaction Qualifications · Basic reading, writing, and arithmetic skills · Strong attention to detail · Strong communication skills, both written and oral · Ability to effectively and professionally handle difficult situations that may arise when working with branches/divisions · Ability to multi-task and manage time efficiently · Knowledge of Microsoft Office and telephone protocol · Familiarity with Accounting terms and procedures (e.g. debits, credits, General Ledgers, etc.) Preferences · Ability to type 50 wpm · Reporting Skills, Administrative Writing Skills, Process Management, Organization, Analysis, Professionalism, Problem Solving, Supply Management, Inventory Control Company Conformance Statement In the performance of assigned tasks and duties all employees are expected to conform to the following: Review and adhere to policies and guidelines contained within the Employee Handbook, including privacy and information security guidelines. Act within delegated authorities and adheres to applicable policy and procedures associated with such authorities. Contribute to establishing a respectful workplace where diversity is critical to innovation and growth. Ensure every action and decision is aligned with PRMI values. Partner with your management team to understand performance expectations and measurements. Effectively utilize feedback and coaching opportunities while seeking to learn and develop within your role at PRMI. Realize team synergies through networking and partnerships across PRMI. Embrace change; act as advocate and role model, promoting an approach of continuous improvement. Maintain a high standard of customer care while actively listening to customers in an effort to understand their views and needs. Take ownership of problems and issues, taking into consideration the breadth of PRMI competencies in providing solutions. Work independently while understanding the necessity for communicating and coordinating work efforts with other employees and organizations. Work effectively as a team contributor on all assignments. Perform quality work within deadlines. Respect client and employee privacy. Work Requirements Each employee must be able to communicate clearly and effectively, utilize a computer, maintain a work schedule, and effectively perform in an office setting. Employment with PRMI requires compliance with and adherence to all applicable mortgage and fair lending laws and regulations as well as PRMI policies. The ability to work extended hours may be required. Nothing in this job description restricts management's right to assign or reassign duties and responsibilities to this job at any time.

**Insurance Claims Specialist** Administrative - Jonesboro, Louisiana Insurance Claims Specialist Peach Tree Dental - Jonesboro Jonesboro, LA 71251 Job details Salary: Starting from $16.00-$20.00/hourly Pay is based on experience and qualifications. **incentives after training vary and are based on performance Job Type: Full-time Full Job Description Please go to to complete your online application and assessments or use the following URL: Qualifications * High school or equivalent (Required) * Takes initiative. * Has excellent verbal and written skills. * Ability to manage all public dealings in a professional manner. * Ability to recognize problems and problem solve. * Ability to accept feedback and willingness to improve. * Ability to set goals, create plans, and convert plans into action. * Is a Brand ambassador, both in and outside of the facility. Benefits offered for Full-time Insurance Claims Specialists: * Medical, Dental, Vision Benefits * Dependent Care & Healthcare Flexible Spending Account * Simple IRA With Employer Match * Basic Life, AD&D & Supplemental Life Insurance * Short-term & Long-term Disability Perks & Rewards for Full-time Insurance Claims Specialists: * Competitive pay + bonus * Paid Time Off & Sick time * 6 paid Holidays a year Location Jonesboro, Louisiana Minimum Experience Mid-level Compensation $16.00 - $20.00

Linde Gas & Equipment Inc. is seeking an Acetylene - Ethylene Cylinder Processor to join our team located in Hahnville, LA. The Acetylene - Ethylene Cylinder Processor will be responsible for filling, labeling & preparation of Acetylene gas trailers and Ethylene cylinders and trailers. Hourly Rate: $25.00 per hour, depending on experience. Responsibilities: (Rotating shift) * Follows POIS procedures for painting, filling, labeling, and preparing for shipment Acetylene gas trailers * Follows POIS procedures for painting, filling, labeling, and preparing for shipment Ethylene cylinders and trailers * Ability to work a rotating 10-hour shift (24/7 operation) * Ability to work weekend and holiday shifts * Operates and maintains Acetylene Compressors and related fill equipment * Must be able to roll and cart cylinders up to 200lbs * Utilizes Digital Control System and ATS to process and fill acetylene trailers * Operates a forklift truck and other plant vehicles * Ability to work Overtime as production requires * Other duties as assigned Requirements * High School Degree/GED required * 2 yrs. experience in plant or manufacturing environment preferred * Strong mechanical background desired * Strong computer skills desired * Qualified candidate must possess good leadership, problem solving, communication, and organizational skills * Must have the ability to work a rotating 12-hour shift (Days, Nights & Weekends) and overtime as needed Linde is a leading global industrial gases and engineering company with 2023 sales of $33 billion. We live our mission of making our world more productive every day by providing high-quality solutions, technologies, and services which are making our customers more successful and helping to sustain and protect our planet. The company serves a variety of end markets including chemicals & refining, food & beverage, electronics, healthcare, manufacturing, and primary metals. Linde's industrial gases are used in countless applications, from life-saving oxygen for hospitals to high-purity & specialty gases for electronics manufacturing, hydrogen for clean fuels and much more. Linde also delivers state-of-the-art gas processing solutions to support customer expansion, efficiency improvements, and emissions reductions. For more information about the company, please visit our website at **************** All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, age, disability, protected veteran status, pregnancy, sexual orientation, gender identity or expression, or any other reason prohibited by applicable law.

Req #54 Louisiana Workers' Compensation Corporation, Baton Rouge, Louisiana, United States of America **Job Description** Posted Sunday, October 20, 2024 at 11:00 PM LWCC is a Champion of Louisiana business and proud to be headquartered in the state capital, Baton Rouge. As a model single-state, private mutual workers' comp company, we promote safety, security, and stability in Louisiana. LWCC is dedicated to excellence in execution, from underwriting to life-long care of injured workers. We are proud to partner with our agents, and together deliver outstanding service to policyholders and their workers. Our commitment is to be there for Louisiana. Always. We are Louisiana Loyal, more than a tagline, this is a mantra and a movement that inspires us to be a catalyst elevating Louisiana's position in America. We hope to inspire other Louisiana businesses and citizens to join us in helping Louisiana thrive by bettering our state one business and one worker at a time. In 2023, the company was named as a Best Place to Work by the Greater Baton Rouge Business Report for the fourth time. LWCC has been recognized by industry leading benchmarker AON and named to the Ward's 50 group of top-performing insurance companies for achieving outstanding results in the areas of safety, consistency, and performance over a five-year period, 2015-2019. Our company offers an excellent benefits package including health, dental, vision, life and disability insurance; a 401(k) savings plan; educational assistance; and an on-site fitness center. LWCC is an equal opportunity employer and does not discriminate on the basis of race, creed, color, national origin, religion, sex, age, handicap, Vietnam era or disabled veteran status. For more information on the corporation and its services, please visit . To learn more about Louisiana Loyal, please visit . **Overview** Integral part of helping Louisiana thrive through efficient and consistent handling of injured workers claims. Investigating assigned claims through completion. Provides unparalleled customer experience for all our stakeholders. **Major Areas of Accountability** * **General** + Participates in a formal training program to develop the knowledge and skills to handle insurance claims involving work-related accidents. Is responsible for the well-being of hundreds of Louisiana employees who are injured. + Examine claims forms and other records to determine insurance coverage. + Interview or correspond with our policyholders, claimants, witnesses, physicians, or other relevant parties to complete investigation. + Investigate facts of loss to determine extent of injury. + Review and understand police reports, medical treatment records, medical bills, and other insurance documents during the duration of the claim. + Adjust reserves or provide reserve recommendations to establish the value of the claim consistent with corporate policies. + Negotiate claim settlement opportunities. + Confer with legal counsel on claims involving litigation. + Takes initiative and manages personal claim caseload in accordance with processes and procedures with a focus on individual, team and departmental goals. + Seeks opportunities for improvement and continued learning + Maintains required LA Workers' Compensation Adjuster License. + Performs other job duties as needed by the department **Personality/Working Style** * **Strong character** + Alignment with company values, mission, and vision + Trustworthy and honest + Decisive + Curious and persistent * **Passion for innovation** + Willingness to learn + Adaptive to changing (tolerance for ambiguity) + Desire to collaborate to achieve corporate goals * **Strong communicator** + Effective communication skills + Empathetic listener and open-minded + Commitment to accountability **Education and Experience** * Bachelor's degree and some work experience, preferably in the insurance industry OR * H.S. Diploma/GED with 4 years of experience as an insurance claims adjuster Scan this QR code and apply! Louisiana Workers' Compensation Corporation, Baton Rouge, Louisiana, United States of America For more information, refer to .