Claim Processor jobs at Magellan Health

What you can expect! Find joy in serving others with IEHP! We welcome you to join us in “healing and inspiring the human spirit” and to pivot from a “job” opportunity to an authentic experience! Under the direction of the Claims Production Manager and Supervisor, the Claims Processor Level II will be processing outpatient professional and institutional claims. This includes but is not limited to; lab, radiology, ambulance, behavior health, outpatient COB, dialysis, oncology/chemo, hospital exclusions etc., in an accurate and expedient manner. Commitment to Quality: The IEHP Team is committed to incorporate IEHP's Quality Program goals including, but not limited to, HEDIS, CAHPS, and NCQA Accreditation. Additional Benefits Perks IEHP is not only committed to healing and inspiring the human spirit of our Members, but we also aim to match our team members with the same energy by providing prime benefits and more. Competitive salary Telecommute schedule State of the art fitness center on-site Medical Insurance with Dental and Vision Life, short-term, and long-term disability options Career advancement opportunities and professional development Wellness programs that promote a healthy work-life balance Flexible Spending Account - Health Care/Childcare CalPERS retirement 457(b) option with a contribution match Paid life insurance for employees Pet care insurance Key Responsibilities Responsible for non-delegated provider claims verification and adjudication. Adjudicate all professional and outpatient claims including COB, denials, and reduction in service notifications. Meet Regulatory Compliance Regulations on turnaround times and claim payments. Read and interpret Medi-Cal/Medicare Fee Schedules. Must be able to make a sound determination if claim is eligible for payment or denial. Interface with other IEHP Departments, when necessary, regarding claims issues. Participate in Claims Department staff meetings, and other activities as needed. Responsible for meeting the performance measurement standards for productivity and accuracy. Any other duties as required to ensure the Health Plan operations are successful. Qualifications Education & Requirements Minimum of two (2) years of experience adjudicating outpatient professional and/or institutional claims preferably in an HMO or Managed Care setting Processing of Medicare, Medi-Cal, or Commercial claims required Proficient in rate applications for Medi-Cal and/or Medicare pricers High school diploma or GED required Key Qualifications ICD-9 and CPT coding and general practices of claims processing Prefer knowledge of capitated managed care environment Microcomputer skills, proficiency in Windows applications preferred Excellent communication and interpersonal skills, strong organizational skills Professional demeanor Must be computer literate, maintain good attendance, and have the right attitude and discipline to work from home Start your journey towards a thriving future with IEHP and apply TODAY! Work Model Location Telecommute (All IEHP positions approved for telecommute work locations may periodically be required to report to IEHP's main campus for mandatory in-person meetings or for other business needs as determined by IEHP leadership) Pay Range USD $23.98 - USD $30.57 /Hr.

What you can expect! Find joy in serving others with IEHP! We welcome you to join us in “healing and inspiring the human spirit” and to pivot from a “job” opportunity to an authentic experience! Under the direction of the Claims Production Manager and Supervisor, the Claims Processor Level II will be processing outpatient professional and institutional claims. This includes but is not limited to; lab, radiology, ambulance, behavior health, outpatient COB, dialysis, oncology/chemo, hospital exclusions etc., in an accurate and expedient manner. Commitment to Quality: The IEHP Team is committed to incorporate IEHP's Quality Program goals including, but not limited to, HEDIS, CAHPS, and NCQA Accreditation. Additional Benefits Perks IEHP is not only committed to healing and inspiring the human spirit of our Members, but we also aim to match our team members with the same energy by providing prime benefits and more. Competitive salary Telecommute schedule CalPERS retirement State of the art fitness center on-site Medical Insurance with Dental and Vision Life, short-term, and long-term disability options Career advancement opportunities and professional development Wellness programs that promote a healthy work-life balance Flexible Spending Account - Health Care/Childcare CalPERS retirement 457(b) option with a contribution match Paid life insurance for employees Pet care insurance Key Responsibilities Responsible for non-delegated provider claims verification and adjudication. Adjudicate all professional and outpatient claims including COB, denials, and reduction in service notifications. Meet Regulatory Compliance Regulations on turnaround times and claim payments. Read and interpret Medi-Cal/Medicare Fee Schedules. Must be able to make a sound determination if claim is eligible for payment or denial. Interface with other IEHP Departments, when necessary, regarding claims issues. Participate in Claims Department staff meetings, and other activities as needed. Responsible for meeting the performance measurement standards for productivity and accuracy. Any other duties as required to ensure the Health Plan operations are successful. Qualifications Education & Requirements Minimum of two (2) years of experience adjudicating outpatient professional and/or institutional claims preferably in an HMO or Managed Care setting Processing of Medicare, Medi-Cal, or Commercial claims required Proficient in rate applications for Medi-Cal and/or Medicare pricers High school diploma or GED required Key Qualifications ICD-9 and CPT coding and general practices of claims processing Knowledge of capitated managed care environment preferred Microcomputer skills, proficiency in Windows applications preferred Excellent communication and interpersonal skills, strong organizational skills Professional demeanor Must be computer literate, maintain good attendance, and have the right attitude and discipline to work from home Data entry involving computer keyboard and screens, filing, and copying of records and/or correspondence Position is eligible for telecommuting/remote work location upon completing the necessary steps and receiving HR approval. All IEHP positions approved for telecommute or hybrid work locations may periodically be required to report to IEHP's main campus for mandatory in-person meetings or for other business needs as determined by IEHP leadership Start your journey towards a thriving future with IEHP and apply TODAY! Work Model Location Telecommute (All IEHP positions approved for telecommute work locations may periodically be required to report to IEHP's main campus for mandatory in-person meetings or for other business needs as determined by IEHP leadership) Pay Range USD $23.98 - USD $30.57 /Hr.

Located in the metropolitan area of Sacramento, the Adventist Health corporate headquarters have been based in Roseville, California, for more than 40 years. In 2019, we unveiled our WELL-certified campus - a rejuvenating place for associates systemwide to collaborate, innovate and connect. Adventist Health Roseville and shared service teams have access to enjoy a welcoming space designed to promote well-being and inspire your best work. Job Summary: Handles day-to-day oversight of general, professional, and other liability claims in accordance with Adventist Health's claims program policies and procedures and within an assigned region or scope of responsibility. Maintains up-to-date and accurate claims files, including summaries, action plans, and claims status in the claims data management software, coordinating with market leadership, risk managers, defense counsel, and others. Receives assignments in the form of strategic objectives and is responsible for determining the appropriate tactical approach, resource allocation, scheduling, and goal setting to achieve desired outcomes. Collaborates with a high level of communication and customer service. Job Requirements: Education and Work Experience: * Bachelor's Degree in risk management, legal studies, nursing, or closely related field or equivalent combination of education/related experience: Required * Master's Degree: Preferred * Three years' related experience managing professional and general liability claims within a hospital system, insurance carrier, self-insured environment, law firm setting, or a combination of these: Preferred Licenses/Certifications: * Associate in Claims: Preferred * Chartered Property Casualty Underwriter: Preferred Essential Functions: * Manages a portfolio of claims from first notice through resolution. Coordinates litigation activity, including working closely with defense counsel, attending mediations, and contributing to legal strategy and trial preparation. Reviews attorney invoices and monitors counsel for compliance within organization policies and guidelines. Reviews and analyzes medical records, interviewes witnesses, assists with the discovery process and communicates with facility risk manager regarding evaluation and investigation. * Establishes and adjusts reserves based within organizational authority level. Develops and implements effective settlement strategies, engaging structured settlement professionals when appropriate. Identifies opportunities for subrogation, contribution, and recovery to reduce total claim costs and enhance overall case outcomes. Selects appropriate medical experts for case review. * Coordinates initial notice to reinsurers and provides timely updates on case status. Maintains accurate and detailed claim files in the claims management system, ensuring documentation of activity, decisions, and communications. Provides direction to support staff. * Notifies manager of identified trends or patterns in claims that may indicate systemic risk or opportunities for clinical improvement. Prepares claim summaries, reports, and dashboards for management and participates in claims review meetings. Develops and documents for each claim or lawsuit a plan of action for resolution by settlement, trial, or other means. * Maintains the electronic file including all material communication, correspondence, analysis, expert opinions, interview summaries and all other material documents in accordance with the claims policies and procedures manual. Provides feedback and recommendations, evaluations, litigation trends, department policies and procedures, system-wide claims and litigation processes, and appropriate system risk management issues. * Performs other job-related duties as assigned. Organizational Requirements: Adventist Health is committed to the safety and wellbeing of our associates and patients. Therefore, we require that all associates receive all required vaccinations as a condition of employment and annually thereafter, where applicable. Medical and religious exemptions may apply. Adventist Health participates in E-Verify. Visit ******************************************** for more information about E-Verify. By choosing to apply, you acknowledge that you have accessed and read the E-Verify Participation and Right to Work notices and understand the contents therein.

Full Time 12238 Silicon Drive Clerical Day Shift $18.75 - $24.25 /RESPONSIBILITIES Performs adjudication of medical (HCFA) or hospital (UB92) claims for Medicaid, Commercial, and CHIP (Children's Health Insurance Program) according to departmental and regulatory requirements. Maintains audit standards as defined by the Department. EDUCATION/EXPERIENCE High school diploma or GED equivalent is required. Two or more years of experience in claim processing and/or billing experience required. Specific knowledge and experience in Medicaid, CHIP and commercial claim processing preferred. Knowledge of ICD-9, CPT 4 coding and medical terminology is required.

What you can expect! Find joy in serving others with IEHP! We welcome you to join us in "healing and inspiring the human spirit" and to pivot from a "job" opportunity to an authentic experience! Under the direction of the Claims Production Manager and Supervisor, the Claims Processor Level II will be processing outpatient professional and institutional claims. This includes but is not limited to; lab, radiology, ambulance, behavior health, outpatient COB, dialysis, oncology/chemo, hospital exclusions etc., in an accurate and expedient manner. Commitment to Quality: The IEHP Team is committed to incorporate IEHP's Quality Program goals including, but not limited to, HEDIS, CAHPS, and NCQA Accreditation. Perks IEHP is not only committed to healing and inspiring the human spirit of our Members, but we also aim to match our team members with the same energy by providing prime benefits and more. * Competitive salary * Telecommute schedule * State of the art fitness center on-site * Medical Insurance with Dental and Vision * Life, short-term, and long-term disability options * Career advancement opportunities and professional development * Wellness programs that promote a healthy work-life balance * Flexible Spending Account - Health Care/Childcare * CalPERS retirement * 457(b) option with a contribution match * Paid life insurance for employees * Pet care insurance Education & Requirements * Minimum of two (2) years of experience adjudicating outpatient professional and/or institutional claims preferably in an HMO or Managed Care setting * Processing of Medicare, Medi-Cal, or Commercial claims required * Proficient in rate applications for Medi-Cal and/or Medicare pricers * High school diploma or GED required Key Qualifications * ICD-9 and CPT coding and general practices of claims processing * Prefer knowledge of capitated managed care environment * Microcomputer skills, proficiency in Windows applications preferred * Excellent communication and interpersonal skills, strong organizational skills * Professional demeanor * Must be computer literate, maintain good attendance, and have the right attitude and discipline to work from home Start your journey towards a thriving future with IEHP and apply TODAY! Pay Range * $23.98 USD Hourly - $30.57 USD Hourly

Grow Healthy If you are as passionate about helping those in need as you are about growing your career, consider AltaMed. At AltaMed, your passion for helping others isn't just welcomed - it's nurtured, celebrated, and promoted, allowing you to grow while making a meaningful difference. We don't just serve our communities; we are an integral part of them. By raising the expectations of what a community clinic can deliver, we demonstrate our belief that quality care is for everyone. Our commitment to providing exceptional care, despite any challenges, goes beyond just a job; it's a calling that drives us forward every day. Job Overview A Provider Dispute Claims Examiner is responsible for analyzing and the adjudication of medical claims as it relates to managed care. Resolve claims payment issues as presented through Provider Dispute Resolution (PDR) process or from claims incident/inquiries. Identifies root causes of claims payment errors and reports to Management. Responds to provider inquiries/calls related to claims payments. Generates and develop reports which include but not limited to root causes of PDRs and Incidents. Collaborates with other departments and/or providers in successful resolution of claims related issues. Minimum Requirements * HS Diploma or GED * 2+ years of Claims Processing experience in a managed care environment. * Must understand to read and interpret DOFRs and Contracts. * Must have an understanding of how to read a CMS-1500 and UB-04 form. * Must have strong organizational and mathematical skills. Compensation $26.91 - $33.53 hourly Compensation Disclaimer Actual salary offers are considered by various factors, including budget, experience, skills, education, licensure and certifications, and other business considerations. The range is subject to change. AltaMed is committed to ensuring a fair and competitive compensation package that reflects the candidate's value and the role's strategic importance within the organization. This role may also qualify for discretionary bonuses or incentives. Benefits & Career Development * Medical, Dental and Vision insurance * 403(b) Retirement savings plans with employer matching contributions * Flexible Spending Accounts * Commuter Flexible Spending * Career Advancement & Development opportunities * Paid Time Off & Holidays * Paid CME Days * Malpractice insurance and tail coverage * Tuition Reimbursement Program * Corporate Employee Discounts * Employee Referral Bonus Program * Pet Care Insurance Job Advertisement & Application Compliance Statement AltaMed Health Services Corp. will consider qualified applicants with criminal history pursuant to the California Fair Chance Act and City of Los Angeles Fair Chance Ordinance for Employers. You do not need to disclose your criminal history or participate in a background check until a conditional job offer is made to you. After making a conditional offer and running a background check, if AltaMed Health Service Corp. is concerned about a conviction directly related to the job, you will be given a chance to explain the circumstances surrounding the conviction, provide mitigating evidence, or challenge the accuracy of the background report.

Grow Healthy If you are as passionate about helping those in need as you are about growing your career, consider AltaMed. At AltaMed, your passion for helping others isn't just welcomed - it's nurtured, celebrated, and promoted, allowing you to grow while making a meaningful difference. We don't just serve our communities; we are an integral part of them. By raising the expectations of what a community clinic can deliver, we demonstrate our belief that quality care is for everyone. Our commitment to providing exceptional care, despite any challenges, goes beyond just a job; it's a calling that drives us forward every day. Job Overview The Claims Examiner II is responsible for analyzing and adjudication of medical claims as it relates to managed care. Performs payment reconciliations and/or adjustments related to retroactive contract rate and fee schedule changes. May resolve claims payment issues as presented through the Provider Dispute Resolution (PDR) process or from claims incidents/inquiries. Identifies root causes of claims payment errors and reports to Management. Responds to provider inquiries/calls related to claims payment. Collaborates with other departments and/or providers in the successful resolution of claims-related issues. Minimum Requirements * HS Diploma or GED * Minimum of 3 years of Claims Processing experience in a managed care environment. * Experience in reading and interpreting DOFRs and Contracts is required. * Experience in reading CMS-1500 and UB-04 forms is required. Compensation $26.91 - $33.53 hourly Compensation Disclaimer Actual salary offers are considered by various factors, including budget, experience, skills, education, licensure and certifications, and other business considerations. The range is subject to change. AltaMed is committed to ensuring a fair and competitive compensation package that reflects the candidate's value and the role's strategic importance within the organization. This role may also qualify for discretionary bonuses or incentives. Benefits & Career Development * Medical, Dental and Vision insurance * 403(b) Retirement savings plans with employer matching contributions * Flexible Spending Accounts * Commuter Flexible Spending * Career Advancement & Development opportunities * Paid Time Off & Holidays * Paid CME Days * Malpractice insurance and tail coverage * Tuition Reimbursement Program * Corporate Employee Discounts * Employee Referral Bonus Program * Pet Care Insurance Job Advertisement & Application Compliance Statement AltaMed Health Services Corp. will consider qualified applicants with criminal history pursuant to the California Fair Chance Act and City of Los Angeles Fair Chance Ordinance for Employers. You do not need to disclose your criminal history or participate in a background check until a conditional job offer is made to you. After making a conditional offer and running a background check, if AltaMed Health Service Corp. is concerned about a conviction directly related to the job, you will be given a chance to explain the circumstances surrounding the conviction, provide mitigating evidence, or challenge the accuracy of the background report.

Grow Healthy If you are as passionate about helping those in need as you are about growing your career, consider AltaMed. At AltaMed, your passion for helping others isn't just welcomed - it's nurtured, celebrated, and promoted, allowing you to grow while making a meaningful difference. We don't just serve our communities; we are an integral part of them. By raising the expectations of what a community clinic can deliver, we demonstrate our belief that quality care is for everyone. Our commitment to providing exceptional care, despite any challenges, goes beyond just a job; it's a calling that drives us forward every day. Job Overview The Claims Examiner II is responsible for analyzing and adjudication of medical claims as it relates to managed care. Performs payment reconciliations and/or adjustments related to retroactive contract rate and fee schedule changes. May resolve claims payment issues as presented through the Provider Dispute Resolution (PDR) process or from claims incidents/inquiries. Identifies root causes of claims payment errors and reports to Management. Responds to provider inquiries/calls related to claims payment. Collaborates with other departments and/or providers in the successful resolution of claims-related issues. Minimum Requirements * HS Diploma or GED * Minimum of 3 years of Claims Processing experience in a managed care environment. * Experience in reading and interpreting DOFRs and Contracts is required. * Experience in reading CMS-1500 and UB-04 forms is required. Compensation $26.91 - $33.53 hourly Compensation Disclaimer Actual salary offers are considered by various factors, including budget, experience, skills, education, licensure and certifications, and other business considerations. The range is subject to change. AltaMed is committed to ensuring a fair and competitive compensation package that reflects the candidate's value and the role's strategic importance within the organization. This role may also qualify for discretionary bonuses or incentives. Benefits & Career Development * Medical, Dental and Vision insurance * 403(b) Retirement savings plans with employer matching contributions * Flexible Spending Accounts * Commuter Flexible Spending * Career Advancement & Development opportunities * Paid Time Off & Holidays * Paid CME Days * Malpractice insurance and tail coverage * Tuition Reimbursement Program * Corporate Employee Discounts * Employee Referral Bonus Program * Pet Care Insurance Job Advertisement & Application Compliance Statement AltaMed Health Services Corp. will consider qualified applicants with criminal history pursuant to the California Fair Chance Act and City of Los Angeles Fair Chance Ordinance for Employers. You do not need to disclose your criminal history or participate in a background check until a conditional job offer is made to you. After making a conditional offer and running a background check, if AltaMed Health Service Corp. is concerned about a conviction directly related to the job, you will be given a chance to explain the circumstances surrounding the conviction, provide mitigating evidence, or challenge the accuracy of the background report.

Get To Know Us! WebTPA, a GuideWell Company, is a healthcare third-party administrator with over 30+ years of experience building unique benefit solutions and managing customized health plans. This is a Full time in office position: 19100 Ridgewood Pkwy San Antonio, TX 78259 Anticipated Training Class Start Dates: 1/5/2026 or 2/2/2026 What is your impact? As a Claim Examiner, you will handle processing and adjudication for healthcare claims. This will include claims research where applicable and a range of claim complexity. What Will You Be Doing: The essential functions listed represent the major duties of this role, additional duties may be assigned. Day-to-day processing of claims for accounts: Responsible for processing of claims (medical, dental, vision, and mental health claims) Claims processing and adjudication. Claims research where applicable. Reviews and processes insurance to verify medical necessities and coverage under policy guidelines (clinical edit logic). Incumbents are expected to meet and/or exceed qualitative and quantitative production standards. Investigation and overpayment administration: Facilitate claims investigation, negotiate settlements, interpret medical records, respond to Department of Insurance complaints, and authorize payment to claimants and providers. Overpayment reviews and recovery of claims overpayment; corrected financial histories of patients and service providers to ensure accurate records. Utilize systems to track complaints and resolutions. Other responsibilities include resolving claims appeals, researching benefits, verifying correct plan loading. What You Must Have: 2+ years related work experience. Claims examiner/adjudication experience on a computerized claims payment system in the healthcare industry. High school diploma or GED Knowledge of CPT and ICD-9 coding required. Knowledge of COBRA, HIPAA, pre-existing conditions, and coordination of benefits required. Must possess proven judgment, decision-making skills and the ability to analyze. Ability to learn quickly and multitask. Proficiency in maintaining good rapport with physicians, healthcare facilities, clients and providers. Concise written and verbal communication skills required, including the ability to handle conflict. Proficiency using Microsoft Windows and Word, Excel and customized programs for medical CPT coding. Review of multiple surgical procedures and establishment of reasonable and customary fees. What We Prefer: Some college courses in related fields are a plus. Other experience in processing all types of medical claims helpful. Data entry and 10-key by touch/sight What We Can Offer YOU! To support your wellbeing, comprehensive benefits are offered. As a WebTPA employee, you will have access to: Medical, dental, vision, life and global travel health insurance Income protection benefits: life insurance, Short- and long-term disability programs Leave programs to support personal circumstances. Retirement Savings Plan includes employer contribution and employer match Paid time off, volunteer time off, and 11 holidays Additional voluntary benefits available and a comprehensive wellness program Employee benefits are designed to align with federal and state employment laws. Benefits may vary based on the state in which work is performed. Benefits for interns and part-time employees may differ. General Physical Demands: Sedentary work: Exerting up to 10 pounds of force occasionally to move objects. Jobs are sedentary if traversing activities are required only occasionally. Sedentary work: Exerting up to 10 pounds of force occasionally to move objects. Jobs are sedentary if traversing activities are required only occasionally. We are an Equal Employment Opportunity employer committed to cultivating a work experience where everyone feels like they belong and can perform at their best in pursuit of our mission. All qualified applicants will receive consideration for employment.

Are you looking for a career that offers both purpose and the opportunity for growth? Parkland Community Health Plan (PCHP) is a proud member of the Parkland Health family. PCHP is a Medicaid Managed Care Organization servicing Texas Medicaid and CHIP in the Dallas Service Area. PCHP works to fulfill of our mission by empowering members to live healthier lives. By joining PCHP, you become part of a team focused on innovation, person-centered care, and fostering stronger communities. As we continue to expand our services, we offer opportunities for you to grow in your career while making a meaningful impact. Join us and work alongside a talented team where healthcare is more than just a job-it's a passion to serve and improve lives every day. Primary Purpose Parkland Community Health Plan's (PCHP's) Claims Adjudicator is responsible for reviewing, adjudicating, and resolving Medicaid healthcare claims within the QNXT system. This role supports efficient claims operations, maintaining high accuracy while meeting production targets and ensuring compliance with TMHP and Medicaid guidelines. This is a Hybrid role with some in-office meetings required. Minimum Specifications Education • High school diploma or equivalent required. Experience • Two (2) years of experience in healthcare claims adjudication required. • Expertise in the QNXT platform preferred. • Experience working with Texas Medicaid claims and Medicaid regulatory requirements is preferred. • Knowledge of NetworX Pricer for claims pricing and reimbursement is a plus. • Excellent verbal and written communication skills including the ability to communicate effectively and professionally across disciplines. Ability to communicate complex information in understandable terms. • Strong interpersonal and conflict resolution skills with the ability to establish and maintain effective working relationships across and beyond the organization. • Excellent analytical and problem-solving skills. • Proficient in adjudicating claims using QNXT, including resolution of pended or denied claims. • Strong understanding of claims adjudication processes, benefit structures, and provider contracts. • Familiarity with the claim's life cycle, including submission, processing, adjudication, and payment processes. • Ability to identify and resolve claim discrepancies effectively and efficiently. • Strong time management and organizational skills with the ability to manage multiple demands and respond to rapidly changing priorities. • Ability to write clearly and succinctly with a high level of attention to detail. • Proficient computer and Microsoft Office skills. Ability to learn new software programs. • Knowledge of Texas Medicaid, National Committee for Quality Assurance (NCQA), the Uniformed Managed Care Contract, and the Uniform Managed Care Manual. Responsibilities Operations • Review and process healthcare claims within the QNXT system, ensuring compliance with benefit policies, pricing, and regulatory guidelines. • Adjudicate claims accurately by analyzing supporting documentation, provider contracts, and fee schedules. • Investigate and resolve pended or denied claims by applying appropriate corrections in QNXT. • Collaborate with internal teams to identify, address, and resolve systemic claims issues. • Meet or exceed established productivity targets for claims adjudication in a high-volume environment. •Effectively prioritize and manage workload to meet deadlines and organizational objectives. • Document claim outcomes, adjustments, and resolutions accurately within the QNXT system. • Provide updates and insights on claims performance metrics to supervisors as needed Quality • Integrate health literacy principles into all communication including Members and Providers. • Support strategies that meet clinical, quality and network improvement goals. • Promote the use of Health Information Technology to support and monitor the effectiveness of health and social interventions and make data-driven recommendations as needed. • For staff in clinical roles, foster collaborative relationships with members and/or providers to promote and support evidence-based practices and care coordination. • Ensures high accuracy in claims adjudication to meet quality standards and maintain compliance with policies and regulations. Regulatory • Ensures work is carried out in compliance with regulatory and/or accreditation standards as well as contractual requirements. • Ensure all claims are adjudicated in alignment with TMHP guidelines, Medicaid regulations, and internal policies. Professional Accountability • Promotes and supports a culturally welcoming and inclusive work environment. • Acts with the highest integrity and ethical standards while adhering to Parkland's Mission, Vision, and Values. • Adheres to organizational policies, procedures, and guidelines. • Completes assigned training, self-appraisal, and annual health requirements timely. • Adheres to hybrid work schedule requirements. • Attends required meetings and town halls. • Recognizes and communicates ethical and legal concerns through the established channels of communication. • Demonstrates accountability and responsibility by independently completing work, including projects and assignments on time, and providing timely responses to requests for information. • Maintains confidentiality at all times. • Performs other work as requested that is reasonably related to the employee's position, qualifications, and competencies. Job Accountabilities 1. Identifies ways to improve work processes and improve customer satisfaction. Makes recommendations to supervisor, implements, and monitors results as appropriate in support of the overall goals of PCHP. 2. Stays abreast of the latest developments, advancements, and trends in the field by attending seminars/workshops, reading professional journals, actively participating in professional organizations, and/or maintaining certification or licensure. Integrates knowledge gained into current work practices. 3. Maintains knowledge of applicable rules, regulations, policies, laws and guidelines that impact the area. Develops effective internal controls designed to promote adherence with applicable laws, accreditation agency requirements, and customer requirements. Seeks advice and guidance as needed to ensure proper understanding. Parkland Community Health Plan (PCHP) prohibits discrimination based on age (40 or over), race, color, religion, sex (including pregnancy), sexual orientation, gender identity, gender expression, genetic information, disability, national origin, marital status, political belief, or veteran status.

Job Details Blackburn's Corporate - Tarentum, PA InsuranceDescription Job Opening: Claims Processing Specialist at Blackburn's Are you a detail-oriented professional with a passion for the healthcare industry? Blackburn's is looking for a Claims Processing Specialist to join our Corporate Claims department and perform third-party medical billing functions. If you thrive in a fast-paced environment and possess excellent organizational and communication skills, this could be the perfect opportunity for you! What You'll Do: Manage and verify third-party medical claims for accuracy and compliance. Collaborate with cross-functional teams to resolve billing discrepancies and insurance denials. Process claims efficiently while adhering to strict filing deadlines. Contribute to the improvement of billing processes to reduce denials and increase efficiency. Utilize your strong communication skills to work with internal teams and external clients. Why Join Us? At Blackburn's, we're committed to creating a positive impact in the healthcare industry by delivering quality products and services. As part of our team, you'll have access to in-house training, opportunities for career growth, and a collaborative work environment. We offer competitive pay, benefits, and the chance to be part of a company that values its employees. Work Hours: 8:00 a.m. - 4:30 p.m. or 8:30 a.m. - 5:00 p.m. If you have a passion for medical billing and enjoy working in a dynamic, fast-paced environment, we'd love to hear from you! Apply today and join us in making a difference at Blackburn's! Qualifications What We're Looking For: Prior experience in healthcare-related industries, preferably with third-party medical billing. Strong attention to detail, time management, and the ability to juggle multiple tasks. Excellent interpersonal skills, with the ability to work both independently and as part of a team. Proficiency in Microsoft Office, with knowledge of Word and Excel. Ability to work independently, prioritize workload, and adapt to changing environments.

Job Description At OneAmerica, we deliver on promises when customers need us most. We believe the best way to serve our customers is to know that every individual, employee, family and business we work with has unique personal and financial goals. We keep our promises, so we can help them achieve their goals and realize their definition of financial success. Job Summary The STD Claims Examiner is responsible for contributing to the overall success of OneAmerica objectives by providing timely and accurate support to our client companies and the Claims department. This individual will be responsible for managing appropriate adjudication of short-term disability claims in accordance with policy provisions. The STD Claims Examiner will initiate and facilitate case management as well as other ancillary services to assure optimum outcomes. We are currently seeking Level I & II Representative experience. KEY RESPONSIBILITIES: Promote a positive customer service image through prompt, accurate and courteous responses to customer information needs Consistently adhere to the documented workflow guidelines and established procedures. Maintain required levels of confidentiality Demonstrate competency in all modules of training program. Remain abreast of industry standards via internal/external continuing education Promptly and thoroughly investigate and evaluate claims within departmental and regulatory guidelines Interpret and administer contract provisions including, but not limited to, eligibility, covered weekly earnings, definition of Total Disability, verification of applicable offsets and pre-existing investigations Calculate benefit and identify other income replacement benefits. Processes financial activities, including, but not limited to, payment adjustments, stop payments, voids and check reissues, other income adjustments, reimbursement checks, and final benefits. Processes overpayments in accordance with established procedures Assist in the subrogation process to recover money from third parties Work in coordination with an LTD Examiner to ensure an appropriate transition from the STD claim to LTD Document claim file actions and telephone conversations appropriately Refer claim activity outside authority level to Supervisor/Manager for review Proactively communicate with claimants, policyholders and physicians to resolve investigations issues Establish, communicate and manage claimant and policyholder expectations Utilize most efficient means to obtain claim information Fully investigates all relevant claim issues, provides payment or denials promptly and in full compliance with departmental procedures and Unfair Claims Practice regulations Respond to customer service issues within required timeframes Involve technical resources (Social Security Specialist, medical resources and vocational resources) at appropriate claim junctures Support relationships with technical resources to achieve appropriate outcomes Meet or exceed departmental service, quality and production objectives Collaborate with team members and management in identifying and implementing improvement opportunities. Informs Supervisor of any trends noted within specific client companies All other duties as assigned REQUIREMENTS: BA/BS or equivalent combination of education and experience 0-2+ years of experience in managing Short Term Disability claims with first pay authority Ability to fluently speak and write Spanish a plus Excellent customer service skills Excellent math and calculation skills Good decision-making skills Ability to analyze complex claim information Working knowledge of Microsoft Excel and Word High School Diploma required, or any combination of education and experience which would provide an equivalent background. Salary Band: 3C #LI-SC1 This selected candidate will be expected to work hybrid in Portland, ME. The candidate will also be expected to physically return to the office in CA, IN or ME as business needs dictate or for team-building and collaboration. If you are offered and accept this position, please be advised that OneAmerica Financial does not have any offices located in the State of New York and OneAmerica Financial associates are not permitted to work remotely in the State of New York. Disclaimer: OneAmerica Financial is an equal opportunity employer and strictly prohibits unlawful discrimination based upon an individual's race, color, religion, gender, sexual orientation, gender identity/expression, national origin/ancestry, age, mental/physical disability, medical condition, marital status, veteran status, or any other characteristic protected by law. For all positions: Because this position is regulated by the Violent Crime Control and Law Enforcement Act, if an offer is made, applicants must undergo mandated background checks as a condition of employment. Such background checks include criminal history. A conviction is not necessarily an absolute bar to employment. Consistent with applicable regulatory guidelines and law, factors such as the age of the offense, evidence of rehabilitation, seriousness of violation, and job relatedness are considered. To learn more about our products, services, and the companies of OneAmerica Financial, visit oneamerica.com/companies.

Job Description We are seeking a Claims Examiner to join our team at Independent Living Systems (ILS). ILS, along with its affiliated health plans known as Florida Community Care and Florida Complete Care, is committed to promoting a higher quality of life and maximizing independence for all vulnerable populations. About the Role: The Claims Examiner plays a critical role in the health care and social assistance industry by thoroughly reviewing and evaluating insurance claims to ensure accuracy, compliance, and appropriateness of payments. This position involves analyzing medical documentation, policy details, and billing information to determine the validity of claims and identify any discrepancies or potential fraud. The Examiner collaborates with healthcare providers, insurance agents, and internal teams to resolve claim issues and facilitate timely reimbursement. By maintaining up-to-date knowledge of healthcare regulations and insurance policies, the Examiner helps protect the organization from financial loss and supports the delivery of fair and efficient claims processing. Ultimately, this role contributes to the integrity and sustainability of the healthcare insurance system by ensuring claims are processed accurately and ethically. Minimum Qualifications: High school diploma or GED Minimum of 2 years experience in claims examination, medical billing, or healthcare insurance processing. Strong understanding of medical terminology, insurance policies, and healthcare billing codes (e.g., ICD-10, CPT). Proficiency with claims management software and Microsoft Office suite. Preferred Qualifications: Associate's degree or Bachelor's degree in health administration, healthcare management, or a related discipline. Certification such as Certified Professional Coder (CPC) or Certified Claims Professional (CCP). Experience working within the health care and social assistance industry or with government healthcare programs. Familiarity with regulatory frameworks such as HIPAA and the Affordable Care Act. Responsibilities: Review and analyze health insurance claims for completeness, accuracy, and compliance with policy terms and regulatory requirements. Verify medical codes, treatment documentation, and billing information to ensure services are properly covered and billed. Investigate and resolve claim discrepancies by communicating with providers, members, and internal departments. Identify and escalate potential fraudulent claims or billing errors to compliance or legal teams. Maintain detailed records of claim evaluations and stay current with healthcare laws and industry standards to support audits and improve processing workflows.

Job Description UNM Medical Group, Inc. is hiring for a Medical Coding Analyst I or II to join our Coding Department. This opportunity is a REMOTE, full-time and day shift opening located in New Mexico. *This is a work from home position that requires the selected candidate to have a permanent address and live in New Mexico or be willing to relocate to New Mexico* *This position is remote, however the selected candidate would need to be available to come into the office in Albuquerque, New Mexico if they experience network or laptop issues* *Sign-On Bonus: $2,000* Medical Coding Analyst 1: Minimum $44,604 - Midpoint $55,766* *Salary is determined based on years of total relevant experience. *Salary is based on 1.0 FTE (full time equivalent) or 40 hours per week. Less than 40 hours/week will be prorated and adjusted to the appropriate FTE. Medical Coding Analyst 2: Minimum $52,038 - Midpoint $65,043* *Salary is determined based on years of total relevant experience. *Salary is based on 1.0 FTE (full time equivalent) or 40 hours per week. Less than 40 hours/week will be prorated and adjusted to the appropriate FTE. Summary: Responsible for coding Inpatient/Outpatient charges and specialty services using appropriate ICD and CPT classification systems for the purpose of reimbursement, research and compliance in accordance with federal regulation. Charges include all Inpatient/Outpatient visits, Day Surgeries, consultations and observation accounts. Specialty services include Interventional Radiology, GI Lab, Pathology, Cardiac Cath Lab, Vascular Lab, Orthopedics, Surgical and Anesthesia procedures. Responsible for review of documentation in medical records to assure that documentation by providers conforms to compliance and legal requirements. Provide feedback for practitioners on coding practices. Coder must meet department productivity and quality standards. Ensure adherence to policies and procedures and guidelines. Minimum Job Requirements or a Medical Coding Analyst I: High School diploma or GED and 6 months directly related experience or successful completion of UNMMG Medical Coding Internship Program. Certification in at least one of the following: RHIT, RHIA, RCC, CIRCC, CSS, CCA, CCS-P, COC, CIC, CPC, CPC-P or CPC-A. Verification of education and licensure (if applicable) will be required if selected for hire. Minimum Job Requirements or a Medical Coding Analyst II: High School diploma or GED and 2 years directly related experience. Certification in at least one of the following: RCC, CPC, CIRCC, CPC-P, CCS, CCS-P, COC, CIC, RHIA, or RHIT. Verification of education and licensure (if applicable) will be required if selected for hire. Duties and Responsibilities: Reviews and analyzes medical records in order to assign appropriate CPT and ICD-10 codes for inpatient and outpatient consultations, procedures, anesthesia, inpatient visits, and office visits for new or established patients. Analyzes as well as resolution of coding edits that occur. Identifies and reviews documentation in an EMR environment to ensure that all required signatures and addendums are present in the medical record(s). Interaction and feedback to providers, when necessary, regarding medical documentation deficiencies or to request clarification of documentation components. Ensures strict confidentiality of medical records and documentation. Follows established departmental policies, procedures and objectives. Why Join UNM Medical Group, Inc.? Since our creation in 2007, our dynamic organization has continued to grow and form strong partnerships within the UNM Health system. Modern Healthcare recognizes UNMMG in their Best Places to Work recognition for 2025. We ASPIRE to incorporate the following values into all aspects of our culture and work: we always demonstrate an Attitude of Service with Positivity, Integrity and Respect as we strive for Excellence. We are dedicated to embracing and promoting diversity while fostering well-being across New Mexico through cultural humility and respect for everyone. Benefits: Competitive Salary & Benefits: UNMMG provides a competitive salary along with a comprehensive benefits package. Insurance Coverage: Includes medical, dental, vision, and life insurance. Additional Perks: Offers tuition reimbursement, generous paid time off, and a 403b retirement plan for eligible employees.

Analyze, plan, design, maintain, and provide ongoing optimization and support of medical imaging systems. Perform workflow assessments, capture business needs and analyze internal business systems to determine functional requirements for optimal utilization. Possess proficient clinical, technical, or application knowledge and experience. Perform system builds, upgrades, and system enhancements as needed. Support application through all phases of implementation, optimization, and maintenance. Work with cross-functional teams and end users to achieve application integration to meet clinical and/or business needs. Contributes to project teams and collaborates to ensure system functionality and user satisfaction. Exercise discretion and judgment in the performance of original, creative, intellectual work. Incumbent is subject to callback and on-call as required. Perform other duties as assigned. Job Responsibilities• Assist in implementation and serve as point person on assignments related to all phases of implementation of medical imaging systems and new projects used in corporate-wide Epic-related information system solutions to meet project milestones.• Analyzes problems, recommends improvement, and develops appropriate action plans utilizing Baptist Management System tools to promote transformation and ensure successful implementation.• Completes testing of software applications using established standards and protocols.• Provides ongoing support of medical imaging systems and other applications under area of responsibility.• Supports system configuration and maintenance tasks, ensuring alignment with clinical workflows and operational requirements.• Collaborates with end users and stakeholders to gather and document requirements, facilitating effective system integration.• Assists in troubleshooting and resolving technical issues in medical imaging systems, escalating complex problems as needed. • Completes assigned goals ExperienceMinimum Required 5 yrs. of relevant experience EducationMinimum Required Bachelor Degree in either Radiology, Computer Engineering or Information Technology. TrainingMinimum Required None Special SkillsMinimum Required Skill and proficiency in communicating and performing the techniques of information systems and/or telecommunications assessment. LicensureMinimum Required DRIVER'S LICENSE (CURRENT)

Job DescriptionDescription: Verda Health Plan of Texas has a contract with the Center of Medicaid and Medicare Services (CMS) and a state license with the Texas Department of Insurance for a Medicare Advantage Prescription Drug (MAPD) plan. We are committed to the idea that healthcare should be easily and equitably accessed by all. Our mission is to ensure that underserved communities have access to health and wellness services, and receive the support needed to live a healthy life that is free of worry and full of joy. We are looking for a Claims Examiner III to join our growing company with many internal opportunities. Are you ready to join a company that is changing the face of health care across the nation? Verda Healthcare health plan is looking for people like you who value excellence, integrity, care and innovation. As an employee, you'll join a team dedicated to improving the lives of our Medicare members. Our vision incorporates value-based health care that works. We value diversity. Align your career goals with Verda Healthcare, Inc. and we will support you all the way. Position Overview The Claims Examiner III performs advanced administrative, operational, and customer support duties that require independent initiative and sound judgment. This position is responsible for the analysis and adjudication of medical claims within a managed care environment. The role includes processing payment reconciliations and adjustments related to retroactive contract rates and fee schedule changes, as well as identifying root causes of claims payment errors and reporting them to management. The Claims Examiner III also manages provider inquiries and supports resolution efforts across departments. This position reports to: Claims Operations Manager. Responsibilities: · Analyze and adjudicate complex medical claims in compliance with CMS guidelines and health plan policies. · Review and apply appropriate fee schedules, contracts, and benefit plans. · Perform claim payment reconciliations and retroactive adjustments. · Identify patterns and root causes of payment discrepancies and escalate issues as needed. · Respond to provider inquiries and coordinate with internal teams for resolution. · Maintain documentation and track resolution outcomes. · Ensure compliance with regulatory, contractual, and internal policies. · Recommend process improvements based on claim trends and data analysis. · Support training initiatives for new staff and peers as subject matter experts. Requirements: Minimum Qualifications · High school diploma or GED required. Associate or bachelor's degree preferred. · Minimum of 3-5 years of experience in claims processing and adjudication, preferably within Medicare Advantage or managed care settings. · Knowledge of CPT, HCPCS, ICD-10 coding, and CMS regulations. · Strong analytical and problem-solving skills. · Proficient in claims systems (e.g., Plexis, Facets) and Microsoft Office tools. · Ability to handle confidential information in compliance with HIPAA. Professional Competencies · Strong attention to detail and accuracy · Excellent verbal and written communication · Customer service-oriented with a collaborative mindset · Ability to work independently and prioritize tasks · Commitment to continuous learning and quality improvement Verda cares deeply about the future, growth, and well-being of its employees. Join our team today! Job Type: Full-time Benefits: 401(k) Paid time off (vacation, holiday, sick leave) Health insurance Dental Insurance Vision insurance Life insurance Schedule: Full-time onsite (100% in-office) Hours of operations: 9am - 6pm Standard business hours Monday to Friday/weekends as needed Occasional travel may be required for meetings and training sessions. Ability to commute/relocate: Reliably commute or planning to relocate before starting work (Required) PHYSICAL DEMANDS Regularly sit/walk at a workstation in an office or cubicle setting. Must occasionally lift and/or move up to 25-50 pounds. * Other duties may be assigned in support of departmental goals.

Get To Know Us! WebTPA, a GuideWell Company, is a healthcare third-party administrator with over 30+ years of experience building unique benefit solutions and managing customized health plans. Training: Monday to Friday 8:00am to 4:30pm Central Time for 4 weeks Training Classes Starting: 11/10/2025 and 12/8/2025 4 week paid training Full-Time position + Benefits What is your impact? As a Claim Examiner, you will handle processing and adjudication for healthcare claims. This will include claims research where applicable and a range of claim complexity. What Will You Be Doing: Day-to-day processing of claims for accounts: Responsible for processing of claims (medical, dental, vision, and mental health claims) Claims processing and adjudication. Claims research where applicable. Reviews and processes insurance to verify medical necessities and coverage under policy guidelines (clinical edit logic). Incumbents are expected to meet and/or exceed qualitative and quantitative production standards. Investigation and overpayment administration: Facilitate claims investigation, negotiate settlements, interpret medical records, respond to Department of Insurance complaints, and authorize payment to claimants and providers. Overpayment reviews and recovery of claims overpayment; corrected financial histories of patients and service providers to ensure accurate records. Utilize systems to track complaints and resolutions. Other responsibilities include resolving claims appeals, researching benefits, verifying correct plan loading. What You Must Have: 2+ years related work experience. Claims examiner/adjudication experience on a computerized claims payment system in the healthcare industry. High school diploma or GED Knowledge of CPT and ICD-9 coding required. Knowledge of COBRA, HIPAA, pre-existing conditions, and coordination of benefits required. Must possess proven judgment, decision-making skills and the ability to analyze. Ability to learn quickly and multitask. Proficiency in maintaining good rapport with physicians, healthcare facilities, clients and providers. Concise written and verbal communication skills required, including the ability to handle conflict. Proficiency using Microsoft Windows and Word, Excel and customized programs for medical CPT coding. Review of multiple surgical procedures and establishment of reasonable and customary fees. What We Prefer: Some college courses in related fields are a plus. Other experience in processing all types of medical claims helpful. Data entry and 10-key by touch/sight What We Can Offer YOU! To support your wellbeing, comprehensive benefits are offered. As a WebTPA employee, you will have access to: Medical, dental, vision, life and global travel health insurance Income protection benefits: life insurance, Short- and long-term disability programs Leave programs to support personal circumstances. Retirement Savings Plan includes employer contribution and employer match Paid time off, volunteer time off, and 11 holidays Additional voluntary benefits available and a comprehensive wellness program Employee benefits are designed to align with federal and state employment laws. Benefits may vary based on the state in which work is performed. Benefits for interns and part-time employees may differ. General Physical Demands: Sedentary work: Exerting up to 10 pounds of force occasionally to move objects. Jobs are sedentary if traversing activities are required only occasionally. Sedentary work: Exerting up to 10 pounds of force occasionally to move objects. Jobs are sedentary if traversing activities are required only occasionally. We are an Equal Employment Opportunity employer committed to cultivating a work experience where everyone feels like they belong and can perform at their best in pursuit of our mission. All qualified applicants will receive consideration for employment.

The Claims Examiner is responsible for examining claims that require review prior to being adjudicated. The examiner will use their resources, knowledge and decision-making acumen to determine the appropriate actions to pay, deny or adjust the claim. Examiners are expected to meet performance expectations in accuracy and efficiency. KEY RESPONSIBILITIES: Examining and adjudicating claims that have pended for review utilizing resources, tools, knowledge and decision-making in determining appropriate actions. Identify claims requiring additional resources and route to the team lead, supervisor or other departments as needed. Enter claims information using the processing software to compute payments, allowable amounts, limitations, exclusions and denials. Identify and communicate trends or problems identified during adjudication process. Contribute to the creation of a pleasant working environment with peers and other departments. Assist in investigating and solving claims that require additional research. Consistently learn and adapt to changes related to claims processing, benefits, limits and regulations. Perform other duties as assigned. QUALIFICATIONS: Self-motivated and able to work with minimal direction. Ability to read and understand claims processing manuals, medical terminology, CPT codes, and perform basic processing procedures. Ability to read and understand health benefit booklets. Demonstrated learning agility. Successful completion of Health Care Sanctions background check. Knowledge in the contracted managed care plan terms and rates. General understanding of unbundling methods, COB, and other over-billing methodologies. Must have high attention to detail. Proficient in Microsoft applications. Ability to perform basic mathematical calculations. Possess strong oral and written communication skills. EDUCATION/EXPERIENCE: High School Diploma or Equivalent required. Two years related work experience in claims processing, claims data entry or medical billing OR medical related education to meet minimum two years required.

You'll want to join Billings Clinic for our outstanding quality of care, exciting environment, interesting cases from a vast geography, advanced technology and educational opportunities. We are in the top 1% of hospitals internationally for receiving Magnet Recognition consecutively since 2006. And you'll want to stay at Billings Clinic for the amazing teamwork, caring atmosphere, and a culture that values kindness, safety and courage. This is an incredible place to learn and grow. Billings, Montana, is a friendly, college community in the Rocky Mountains with great schools and abundant family activities. Amazing outdoor recreation is just minutes from home. Four seasons of sunshine! You can make a difference here. About Us Billings Clinic is a community-owned, not-for-profit, Physician-led health system based in Billings with more than 4,700 employees, including over 550 physicians and non-physician providers. Our integrated organization consists of a multi-specialty group practice and a 304-bed hospital. Learn more about Billings Clinic (our organization, history, mission, leadership and regional locations) and how we are recognized nationally for our exceptional quality. Your Benefits We provide a comprehensive and competitive benefits package to all full- and part-time employees (minimum of 20 hours/week), including Medical, Dental, Vision, 403(b) Retirement Plan with employer matching, Defined Contribution Pension Plan, Paid Time Off, employee wellness program, and much more. Click here for more information or download the Employee Benefits Guide. Magnet: Commitment to Nursing Excellence Billings Clinic is proud to be recognized for nursing excellence as a Magnet-designated organization, joining only 97 other organizations worldwide that have achieved this honor four times. The re-designation process happens every four years. Click here to learn more! Pre-Employment Requirements All new employees must complete several pre-employment requirements prior to starting. Click here to learn more! Claims Specialist I/Government (Full-time) PATIENT FINANCIAL SERVICES - 120.8855 (ROCKY MOUNTAIN PROFESSIONAL BUILDING) req10854 Shift: Day Employment Status: Full-Time (.75 or greater) Hours per Pay Period: 1.00 = 80 hours every two weeks (Non-Exempt) Starting Wage DOE: $17.00 - 21.25 The Claim Specialist's main focus is to obtain maximum and appropriate reimbursement for all claims from government and third-party payers. The Claims Specialist is responsible for preparing and submitting timely and accurate insurance claims to government and third-party payers, assisting in the implementation of payer regulations and ensuring compliance to the regulatory requirements, and verifying payments and adjustments are appropriately applied to accounts based on government, contract or other regulations or agreements. The Claims Specialist is responsible for appropriate follow up on all accounts pending payment from government and third-party payers. Essential Job Functions * Supports and models behaviors consistent with the mission and philosophy of Billings Clinic and department/service. * Responsible for submission of timely and accurate claims to primary, secondary, and tertiary insurances for both electronic and paper submission. Generates telephone calls to insurance carriers to follow up on insurance using reports generated for this purpose to ensure the timely collection of money due on the account. * Audits accounts by verifying that reimbursement amounts are appropriate, coordination of refunds, if appropriate, and coordinating adjustments when necessary, claims appeals or resubmissions, moving balances from insurance responsibility to patient responsibility when appropriate, and reviews and resolves credit balances. * Ensure that claims have appropriate information on them for submission to insurance companies or agencies by reviewing errors and other prebilling insurance reports/worklists. Analyzes and review claims to ensure that payer specific regulations and requirements are met. * Prepares and presents verbally and in writing challenges to third party payers for additional reimbursement for denied charges and/or reductions in reimbursement as appropriate. * Provides guidance and or assistance to the cashiers. * Provides timely follow-up on correspondence received from the insurance carrier or patient. * Responds to inquiries from customers/other departments/insurance carriers regarding insurance coverage issues, coordination of benefits, reconciliation of account balances and complaints regarding services received. Initiates appropriate follow-up on outstanding issues. * Sets up registration and insurance information when necessary. * Utilizes performance improvement principles to assess and improve quality. * Identifies needs and sets goals for own growth and development; meets all mandatory organizational and departmental requirements. * Maintains competency in all organizational, departmental and outside agency environmental, employee or patient safety standards relevant to job performance. * Performs other duties as assigned or needed to meet the needs of the department/organization. Minimum Qualifications Education * High School or GED Experience * One year of previous office experience * Patient accounts or insurance billing experience preferred Or an equivalent combination of education and experience relating to the above tasks, knowledge, skills and abilities will be considered Billings Clinic is Montana's largest health system serving Montana, Wyoming and the western Dakotas. A not-for-profit organization led by a physician CEO, the health system is governed by a board of community members, nurses and physicians. Billings Clinic includes an integrated multi-specialty group practice, tertiary care hospital and trauma center, based in Billings, Montana. Learn more at ****************************** Billings Clinic is committed to being an inclusive and welcoming employer, that strives to be kind, safe, and courageous in all we do. As an equal opportunity employer, our policies and processes are designed to achieve fair and equitable treatment of all employees and job applicants. All employees and job applicants will be provided the same treatment in all aspects of the employment relationship, regardless of race, color, religion, sex, gender identity, sexual orientation, pregnancy, marital status, national origin, age, genetic information, military status, and/or disability. To ensure we provide an accessible candidate experience for prospective employees, please let us know if you need any accommodations during the recruitment process.