: Business hours w flexibility. May be occasional travel throughout the system. Reporting to the Director of Benefits... to prepare appropriate responses. Oversees the ERISA Claim appeal process, where applicable. Financial Ownership: Assists...
of a claim and the payment of such claim are in compliance with the contractual, regulatory and custom plan guidelines.... Project management of Pharmacy Audits from implementation through closure. Manage and perform audits of pharmacy claim...
on a regular basis. Within Utilization Review, provides administrative support to the Medical Director, Utilization Review... codes using the correct coding initiative and outpatient claim edits. Measure trends and work with areas to decrease edits...
of the appeal. Make an appropriate administrative determinations as to whether a claim should be approved or denied based... Director. Determine whether additional pre service, appeal or grievance reviews are required and/or whether additional appeal...
overview materials in conjunction for review and approval by the TSB. Engage the Director of Policy & External Affairs on an ad... to technology, and other inputs to provide expert advice to the Director of Policy & External Affairs, executive leadership...
errors. Prepares, audits and distributes unemployment claim activity reports to property management. Attends... a timely manner Ensures employee issues are referred to the Department Manager for resolution or escalated to the Director...
work environment while aligning with Padre Dam's Safety Standards. Under administrative direction from the Director... and regulations; Worker's Compensation, liability and property claim management; Current training methods and techniques; Crisis...
outpatient pharmacy benefit coverage (inclusion/exclusion), prescription claim problems, communicates drug formulary guidelines... related computer searches for pharmacists and Medical Director to assist in case specific reviews and drug evaluations...
information as necessary for claim adjudication. Remains up-to-date on regulatory requirements through informal and formal updates... use. Reviews claim adjustment reason codes or explanations of benefits received by the payer to determine what reasons for denials...
and implement risk management efficiency projects. · Assist Director in completing the annual Federal Torts Claim Act application... will report directly to the Director of Emergency Operations & Risk Management (Director of EO & RM) and will be responsible...
information, claim forms, search for a provider, and more. CLOSING DATE: Open until filled EEO Statement: The Montgomery... inquiries regarding non-discrimination policies: Director of Human Resources and Assistant Director of Human Resources 750...
About the Opportunity The GEAR UP Program Coordinator reports to the Director of GEAR UP NC. This position... UNC System Office (includes PBS NC, NCSEAA, and NC Arboretum) is a VEVRAA Federal Contractor. To claim veteran...
information, claim forms, search for a provider, and more. CLOSING DATE: Open until filled EEO Statement: The Montgomery... inquiries regarding non-discrimination policies: Director of Human Resources and Assistant Director of Human Resources 750...
Service Team and any Vendor teams. Working closely with Senior Director to ensure KPI’s, strategic vision and changes.... Assist Director in developing various KPI’s, and metrics for the RCM-Senior Living Team. Responsible to work with RCM...
/Authorization team(s) and PFS-Customer Service Team and any Vendor teams. Working closely with Senior Director to ensure KPI.../Authorization team(s) and PFS-Customer Service team. Assist Director in developing various KPI’s, and metrics for the RCM-Senior...
. SUPERVISION RECEIVED AND EXERCISED: Receives supervision from the Assistant Director, Drop In Child Care Center. Duties... director, shall furnish a Statement signed by a licensed physician or an authorized health professional...
are addressed by the psychology director or supervisor. Interested in learning more? Additional details regarding this position... your answers to the supplemental application questions, you must attach a copy of your college transcripts for your claim...
. Employees at the director level and up accrue additional days. We also observe 12 paid holidays and provide up to 2 paid... for operations and maintenance, claim settlements on operations and maintenance contracts, and other matters requiring the approval...
GENERAL SUMMARY: Support new healthcare data analytic capabilities for premium, enrollment, claims and non-claim... risks and issues to the director regularly. PRINCIPLE DUTIES AND RESPONSIBILITIES: Conducts analysis associated...
. Please attach any credentials you claim (degrees, certifications, etc.) to your application. ***Other Food Support Worker... Service Director with direct supervision from the Food Production and Services Supervisor in the day-to-day food service...