Community Health Systems IncBilling Specialist - Clinics Community Health Systems IncBilling Specialist - ClinicsHattiesburg, MSThis position serves as the primary contact for insurance companies and other payers, researching and resolving claim issues while maintaining compliance with billing regulations and organizational policies. The Billing Specialist I is responsible for performing insurance claim processing, billing, and follow-up to ensure timely and accurate reimbursement.
Molina Healthcare IncMedical Review Nurse -UM/Post Appeals (Michigan RN license req) Molina Healthcare IncMedical Review Nurse -UM/Post Appeals (Michigan RN license req)Hattiesburg, MSREQUIRED QUALIFICATIONS: At least 2 years clinical nursing experience, including at least 1 year of utilization review (prospective, retrospective and concurrent clinical review), medical claims review, long-term services and supports (LTSS), claims auditing, medical necessity review and/or coding experience, or equivalent combination of relevant education and experience. Utilizing clinical knowledge and experience, responsible for review of documentation to ensure medical necessity and appropriate level of care utilizing MCG/InterQual, state/federal guidelines, billing and coding regulations, and Molina policies; validates the medical record and claim submitted support correct coding to ensure appropriate reimbursement to providers.
Molina Healthcare IncSpecialist, Appeals & Grievances (Must live in TX and Medicaid experience) Molina Healthcare IncSpecialist, Appeals & Grievances (Must live in TX and Medicaid experience)Hattiesburg, MSRequests and reviews medical records, notes, and/or detailed bills as appropriate; formulates conclusions per protocol and other business partners to determine response; assures timeliness and appropriateness of responses per state, federal and Molina guidelines. Facilitates comprehensive research and resolution of appeals, disputes, grievances, and/or complaints from Molina members, providers, and related outside agencies to ensure that internal and/or regulatory timelines are met.
MaximusData Conversion Lead MaximusData Conversion LeadHattiesburg, MSFull timeMaximus compensation is based on various factors including but not limited to job location, a candidate's education, training, experience, expected quality and quantity of work, required travel (if any), external market and internal value analysis including seniority and merit systems, as well as internal pay alignment. If you require assistance at any stage of the employment process-including accessing job postings, completing assessments, or participating in interviews,-please contact People Operations at applicantaccom@maximus.com.