Medical Claims Processor GlobalchannelmanagementMedical Claims ProcessorParamus, New JerseyPartner with the clearing house to distribute patient billing statements and monitor the patient portal to post payments in the EHR system. Medical Claims Processor duties: Review medical claims and transmit to the insurance carrier using the practice electronic health records (EHR) system and clearing house.
Bill Processor New Jersey ManufacturersBill ProcessorTrenton, New JerseyWith a nationally ranked reputation for outstanding customer service and a history that spans more than a century, NJM is a leading provider of worker's compensation, automobile, and homeowners insurance in New Jersey. Our MCS (Medical Claims Services) Medical Bill Processing Department has an opening for a Bill Processor and is seeking a candidate who has excellent communication skills as well as strong organizational and time management skills.
Processor, eBay - NJ (temp-to-hire) Collaborative SolutionsProcessor, eBay - NJ (temp-to-hire)Jersey City, New JerseyWe grade, authenticate, vault, and sell millions of record-setting collectibles, all while modernizing and digitalizing the process to further our mission of helping collectors pursue their passions. We grade, authenticate, vault and sell millions of record-setting collectibles, all while modernizing and digitalizing the process to further our mission of helping collectors pursue their passions.
Processor , eBay (Temp-To-Hire) (Shift 2) Collaborative SolutionsProcessor , eBay (Temp-To-Hire) (Shift 2)Jersey City, New JerseyWe grade, authenticate, vault, and sell millions of record-setting collectibles, all while modernizing and digitalizing the process to further our mission of helping collectors pursue their passions. Our services span collectible trading cards, autographs, comic books, coins, video games, event tickets, and memorabilia.
Processor, Ebay - NJ (Temp-To-Hire) Collectors Universe, Inc.Processor, Ebay - NJ (Temp-To-Hire)Jersey City, NJWe grade, authenticate, vault, and sell millions of record-setting collectibles, all while modernizing and digitalizing the process to further our mission of helping collectors pursue their passions. We grade, authenticate, vault and sell millions of record-setting collectibles, all while modernizing and digitalizing the process to further our mission of helping collectors pursue their passions.
Processor , Ebay (Temp-To-Hire) (Shift 2) Collectors Universe, Inc.Processor , Ebay (Temp-To-Hire) (Shift 2)Jersey City, NJWe grade, authenticate, vault, and sell millions of record-setting collectibles, all while modernizing and digitalizing the process to further our mission of helping collectors pursue their passions. Our services span collectible trading cards, autographs, comic books, coins, video games, event tickets, and memorabilia.
Processor , eBay (Temp-To-Hire) (Shift 2) Collectors Holdings, Inc.Processor , eBay (Temp-To-Hire) (Shift 2)Jersey City, NJWe grade, authenticate, vault, and sell millions of record-setting collectibles, all while modernizing and digitalizing the process to further our mission of helping collectors pursue their passions. Our services span collectible trading cards, autographs, comic books, coins, video games, event tickets, and memorabilia.
Business Systems Analyst - No Surprises Act Contech SystemsBusiness Systems Analyst - No Surprises ActNewark, NJ$50–$75 / hourThis individual will work closely with business stakeholders, operations teams, and technology teams to analyze business processes, define requirements, and support enhancements to systems responsible for NSA compliance, claims processing, and reimbursement workflows. Our client is seeking an experienced Business Systems Analyst with a strong background in the U.S. healthcare payer industry to support initiatives related to the No Surprises Act (NSA).
Managed Care Coordinator Integrated Resources, IncManaged Care CoordinatorNewark, New JerseyContractorSpecialized knowledge/skills: Requires knowledge of medical terminology Requires knowledge of a claims processing platform with health insurance carrier (i.e., FACETS, QBLUE, etc.) Requires Good Oral and Written Communication skills Requires ability to make sound decisions under the direction of Supervisor Prefer knowledge of benefit contracts, enrollment, billing & claims coding/processing Prefer knowledge Managed Care principles and/or Medicaid Prefer the ability to analyze and resolve problems with minimal supervision Prefer the ability to use a personal computer and applicable software and systems Team Player, Strong Analytical, Interpersonal Skills. Job Summary: This position supports the Health Services and Utilization Management functions and acts as a liaison between Members, Physicians, Delegates, Operational Business members and Member Service Coordinators.
NewClaim Benefit Specialist CVS Health CorpClaim Benefit SpecialistNJ$17–$28.46 / hourAnalyzes claims data and generate reports to identify trends, patterns, or areas for improvement to help inform process enhancements, policy changes, or training needs within the claims processing department. Documents claim information in the company system, assigning appropriate codes, modifiers, and other necessary data elements to ensure accurate tracking, reporting, and processing of claims.
Business System Analyst Level 3 Integrated Resources, IncBusiness System Analyst Level 3Pennington, New JerseyContractorThis position is responsible for gathering requirements from internal and external clients, providing business and technical expertise in support of the business area, providing configuration expertise during design/build sessions to find the most appropriate solution as well as ensuring that the proposed solutions support and enhance business operations. The Business System Analyst Level 3 elicits, analyzes, performs preliminary testing, communicates and validates requirements for changes to business processes, policies and transaction processing by creating Functional and Configuration documentation including development, technical, and implementation.
Business Analyst With Pharmacy Benefit Management - Remote The Dignify Solutions, LLCBusiness Analyst With Pharmacy Benefit Management - RemoteEdison, NJRemoteCandidate should have deep understanding of First Data Bank (FDB) Drug nomenclature and how to use FDB nomenclature in designing / configuring drug coverage (inclusions/exclusions/PA Criteria) or building Formulary / Preferred Drug Lists. Willing to consider less experienced candidates who can demonstrate depth in understanding PBM area.
IBR Senior Analyst Zelis Healthcare, Inc.IBR Senior AnalystNJ$79,000–$99,750 / yearThis is a place for builders with a growth mindset who act with agility, embrace change, and use modern technology to shape smarter solutions, exceptional experiences, and the future of our industry for our clients, customers, and our culture. The Itemized Bill Review Senior Analyst will be responsible for analyzing hospital claims for adherence to proper billing guidelines and will work closely with Expert Claims Review staff to efficiently adhere to policies and procedures for claims processing.
Medicare Pricing Analyst Wisconsin Physicians Service Insurance CorpMedicare Pricing AnalystNJRemoteThe Medicare Pricing Procedures Analyst also researches and responds to interdepartmental requests, reviews Medicare pricing guidance, supports system testing and validation, maintains internal documentation, and assists the Technical Claims team with projects that improve the accuracy and efficiency of Medicare pricing operations. This role supports the implementation and validation of CMS pricing updates, maintains pricing information within Medicare systems, and collaborates with CMS, Shared System Maintainers, and other Medicare Administrative Contractors (MACs) to ensure accurate and timely claims payment.
Member Advocate - Insurance Specialist Integrity Health, LLCMember Advocate - Insurance SpecialistHamilton Township, NJ$19.83–$23.88 / hourFull timeQualificationsStrong interpersonal skillsRobust understanding of health insurance benefits and claims processingProfessional communications, including writing and strong in-person relationship skills with clients and external contractorsProficiency in Microsoft Office Suite: Outlook, Word, and Excel specificallyCandidate must have the ability to work independently, as well as collaborate as a team playerExperience in health insurance administration and claims processing EducationBachelors preferred; Or equivalent of 4+ years' experience Integrity Health manages health plans for public employers using our dedicated Partnership Health Center as a primary care "home-base" for their employees. Member Advocate Job Functions, including but not limited to:Assist members with questions regarding benefits, network access, prior authorizations, and claim processingManage certain insurance carrier communications for membersBuild and maintain relationships with client's administrative personnel to ensure client satisfaction, including but not limited to assisting with administration of wellness programs, health fairs, and health center promotional effortsProvide administrative support to clinical staff as directed, including provider credentialing processes and vaccinations programs.
DSNP Supervisor, RN Integrated Resources, IncDSNP Supervisor, RNMount Laurel, New JerseyFull timeJob Summary: The position is responsible for leading the Dual Special Needs Plan (DSNP) clinical care team in a hands-on manner to provide exceptional service to the customer and contain medical claims cost. Knowledge: Requires knowledge of Utilization Management (UM) and managed care principles as they relate to the CCM process and Elderly Frail /Managed Medicaid Population based CM.
Data Reporting Analyst Integrated Resources, IncData Reporting AnalystEwing Township, New JerseyFull timeWorking with marginal oversight, the incumbent is responsible for performing complex research, analysis, and reporting of network utilization, cost containment and key operational information. Responsible for producing reports from various sources to provide the department/division with actionable information or business intelligence.
Account Manager III- Stop Loss Integrated Resources, IncAccount Manager III- Stop LossNewark, New JerseyFull timeThis specialist position will focus on growing Client's book of business in addition to coordinating with our preferred stop loss vendors by acting as a liaison between sales, marketing, underwriting, preferred vendors, brokers and other key stakeholders both internally and externally. · Coordinates with sales and underwriting on all upcoming renewals and new business opportunities that will maximize the potential for account retention and initial premium and enrollment growth which a focus on profitability.
Contract Manager Integrated Resources, IncContract ManagerNewark, New JerseyFull timeKnowledge/Skills/Abilities: Must be proficient and possess advanced skills in the use of personal computers and supporting software in a Windows based environment, including MS Office products (Word, Excel, PowerPoint) and Outlook; Should be knowledgeable in the use of intranet and internet applications. Responsibilities: Manages contract renewals and ensures services are provided that will maximize the potential for account retention and initial member enrollment.
NewMember Advocate - Insurance Specialist - Brick and Hamilton, NJ Integrity Health, LLCMember Advocate - Insurance Specialist - Brick and Hamilton, NJHamilton Township, NJ$50,000–$60,000 / yearFull timeMember Advocate – Brick & Hamilton Partnership Health CentersFull-Time | $50,000–$60,000 annually | Brick & Hamilton, NJ Integrity Health is looking for a self-disciplined, energetic, compassionate, and service-oriented Member Advocate to join our growing Partnership Health Center team. The Member Advocate will support members and their dependents with healthcare and benefit-related questions and serve as a trusted resource in navigating the healthcare system.