RN Case Manager Emergency, Allegheny General Highmark IncRN Case Manager Emergency, Allegheny GeneralPittsburgh, PAExpands industry knowledge base for professional growth and development while providing ongoing applicable education to the patient, family, physician(s), and other members of the interdisciplinary team (IDT) including, but not limited to, appropriateness of care, documentation requirements, severity of illness and intensity of services criteria, insurance benefits/requirements/limits, discharge planning requirements, length of stay and resource utilization issues. This job oversees, develops, and manages the end-to-end claims functions and operational inputs including but not limited to the receipt of claims, operational correspondences, and corporate correspondences for multiple customer segments; fully utilizes the support mechanisms available to complete the required delivery of high-performance, efficient, and low-cost production.
RN Case Manager Inpatient, Allegheny General Highmark IncRN Case Manager Inpatient, Allegheny GeneralPittsburgh, PAExpands industry knowledge base for professional growth and development while providing ongoing applicable education to the patient, family, physician(s), and other members of the interdisciplinary team (IDT) including, but not limited to, appropriateness of care, documentation requirements, severity of illness and intensity of services criteria, insurance benefits/requirements/limits, discharge planning requirements, length of stay and resource utilization issues. This job oversees, develops, and manages the end-to-end claims functions and operational inputs including but not limited to the receipt of claims, operational correspondences, and corporate correspondences for multiple customer segments; fully utilizes the support mechanisms available to complete the required delivery of high-performance, efficient, and low-cost production.
Pharmacy Benefit Verification Specialist Onco360 PharmacyPharmacy Benefit Verification SpecialistPittsburgh, PennsylvaniaSkills/Knowledge: Required: Pharmacy insurance and benefit verification, PBM and Medical contracts, knowledge/understanding of Medicare, Medicaid, and commercial insurance, pharmacy test claim and NCPDP claim rejection resolution, coordination of benefits, NDC medication billing, pharmacy or healthcare-related knowledge, knowledge of pharmacy terminology including sig codes, and Roman numerals, brand/generic names of medication, basic math and analytical skills, Intermediate typing/keyboarding skills. Pharmacy Benefit Verification Summary The Benefit Verification Specialist will investigate, review, and load accurate patient insurances, including medical and pharmacy coverage, assign coordination of benefits, run test claims to obtain a valid insurance response on patient medications, investigate/identify authorization requirements needed to obtain medication coverage, and enroll eligible patients in copay card assistance programs.
Corporate Counsel Brayman Construction CorpCorporate CounselSaxonburg, PAReporting to the CFO, you will partner with executive leadership, operations, project management, finance, safety, and HR to provide practical legal guidance that supports complex heavy civil infrastructure projects while protecting the company's interests. We are a leading heavy civil and geotechnical contractor with office headquarters in suburban Pittsburgh, Pennsylvania, and a satellite office in Wytheville, Virginia, and various project field offices in the Mid-Atlantic and Northeast Regions.
Prior Authorization Certified Pharmacy Technician Shields Health SolutionsPrior Authorization Certified Pharmacy TechnicianPittsburgh, PA$19.45–$22.21 / hourPatient Support Advocate, Pharmacy Technician, CPhT, Medication Access Specialist, Prior Authorization Specialist, Patient Advocate, Pharmacy Insurance Specialist, Medication Adherence, Healthcare Customer Service, Specialty Pharmacy, Pharmacy Support, Financial Assistance Programs, Insurance Verification, Healthcare Operations, Patient Care Coordinator, Certified Pharmacy Technician, PTCB, NHA . Solid computer skills are required, including proficiency in Microsoft Office tools (Outlook, Teams, Word, Excel, and PowerPoint) for communication, documentation, and data management, as well as, navigating the internet and web-based platforms.
Investigations Consultant Highmark IncInvestigations ConsultantPittsburgh, PAAnalyze and evaluate claim processes specific to professional, hospital, ambulatory surgical center, home health and durable medical equipment to identify key areas of risk exposure and develop plans to mitigate risks and maximize financial recoveries/savings. In connection with this, all employees must comply with both the Health Insurance Portability Accountability Act of 1996 (HIPAA) as described in the Notice of Privacy Practices and Privacy Policies and Procedures as well as all data security guidelines established within the Company's Handbook of Privacy Policies and Practices and Information Security Policy.
Manager Financial Investigations and Provider Review Highmark IncManager Financial Investigations and Provider ReviewPittsburgh, PA3 years" experience in (1) provider overpayment identification and settlement and/or (2) fraud, waste and abuse (FWA) investigations including interactions with federal, state, and local law enforcement and regulatory agencies including negotiating Provider/Facility overpayment settlements and/or (3) audit consulting experience in the healthcare field with strong relationship and project management skills. Strong and effective verbal and written communication skills; Effectively presents complex topics in a concise manner to audiences at various levels and various sizes; Demonstrates the ability to effectively persuade others to listen, commit, and act on a new approach.
Billing Specialist - Revenue Cycle Management Vital Care Infusion ServicesBilling Specialist - Revenue Cycle ManagementMonroeville, PennsylvaniaRemoteRequired Skills/Abilities: Excellent communications skills; listening, speaking, understanding, and writing English while influencing patients, caregivers, payer representatives, and others, answering questions, and advancing reimbursement and collection efforts. Income protection programs include company-sponsored basic life insurance and long-term disability insurance, as well as employee-paid voluntary life, accident, critical illness, and short-term disability insurance.
Insurance Coverage Associate Attorney GpacInsurance Coverage Associate AttorneyPittsburgh, PARemote115000–180000GPAC (Growing People and Companies) is an award-winning search firm specializing in placing quality professionals within multiple industries across the United States since 1990. We are extremely competitive, client-focused and realize that our value is in our ability to deliver the right solutions at the right time.
\n Dental Front Desk Coordinator\n Heartland Dental Care\n Dental Front Desk Coordinator\nGreensburg, PAJoin a 10 person team that thrives on collaboration, communication, and communityA fast paced, family oriented environment with modern equipment and systems Minimum Qualificationsxa0Experience working in a fast-paced and customer-centric environmentExcellent communication and organizational skillsThe position will have access to minimum PHI necessary for performing job-related functions; regular HIPAA training, aligning with the specific role and responsibilities, will be required; and the individual will need to protect PHI and maintain data safeguards.xa0Preferred Reasonable accommodations may be made to enable individuals with disabilities to perform the essential duties of the positionProlonged periods sitting at a desk and working on a computerMust be able to lift up to 15 pounds at timesAvailability to attend virtual training sessions (or in-person)xa0periodically throughout the yearAs part of our commitment to maintaining a safe and healthy environment for both team members and patients, a tuberculosis (TB) test is required for all new hires in dental office positions.
\n Dental Front Desk Assistant\n Heartland Dental Care\n Dental Front Desk Assistant\nWexford, PAMore about the roleGreet and welcome patients as they enter the officexa0to create a great first impression of our teamManagexa0front office duties, including answering phones, checking office mail and email, communicating with patients and insurance companiesUtilize Dentrix for patient scheduling and recordsSchedule and confirm appointments for multiple providers in the officeFile patient insurance claims and follow up on outstanding claims, verification of benefits and explanation of coverage Post insurance and patient payments and process accounts receivablesReview treatment plan fees and payment options with patientsPartner with the providers and team to implement Heartland Dental systems to optimize office potentialxa0What You'll Gainxa0Competitive benefits including health insurance, retirement savings plans, six paidxa0holidays,xa0and PTO (paid time off)Front loaded educationxa0and training, providing youxa0thexa0opportunity to develop to your full potentialOpportunity to be a part of a secure company with 20+ years of industry leading experience that provides a stable career with unlimited growth potentialAccess to on-demand Daily Payxa0About Wexford Dental Arts LLCWexford Dental Arts LLC, like each Heartland Dental supported office, is unique to the community and the patients they serve.xa0 n n n n Applynn n n n n n Save Jobn n n n n nn Share Jobnn Backnnn n Current employees, please apply here.n n n n n n n nn n n n Job Detailsn n n n n n nn n Req ID:n 117390n n n Supported Practice:n Wexford Dental Arts, LLCn n n Category:n Business Assistantn n n Location:n 103 N Meadows Dr, nnWexford, nPA 15090nn n n n n Years of Experience:n No Experience Required (open to experience or new grad)n n n n n nnn n n n n Position Summary:n n xa0Supporting our front office as a Business Assistant, you'll be surrounded by camaraderie and partnership - where patients come first, and continuous learning is encouraged!xa0 Hard-working and motivated, the successful candidate will bring a passion for helping our team provide the best patient care to the communities they serve.
Repair Advisor / CSR MotocruitRepair Advisor / CSRMonroeville, PennsylvaniaEnsure a smooth vehicle delivery process and review completed repairs with customers. · Work closely with estimators and production staff to track repair progress.
Origami Risk Delivery Manager Deloitte Touche Tohmatsu LtdOrigami Risk Delivery ManagerPittsburgh, PA$148,200–$292,300 / yearEngagements span Deloitte offerings and could include developing underwriting, distribution, and claims transformation plans, modernizing specific business and enterprise functions, re-designing operating models and organizational structures, implementing digital experience and advanced analytics solutions, and integrating functions across multiple organizations. The team collaborates with practitioners across Deloitte's different service offerings to deliver advice to formulate business strategy and strategic plans to leading insurance organizations and to implement solutions to execute on those plans and aid our clients in navigating complex engagements and organizational change.
Reconstruction Estimator Paul Davis Restoration of Western PennsylvaniaReconstruction EstimatorBeaver Falls, PAFull timeRESPONSIBILITIES/TASKS: Restoration Estimators work with owners, adjusters, and Project Managers after traumatic events such as a fire or flood to clean up and repair damage to residential and commercial property. Maintain professionalism with project conditions: (i.e. workmanship, homeowner relationships, safety, cleanliness, and tradespeople conduct).
Reconstruction Estimator Paul Davis RestorationReconstruction EstimatorBeaver Falls, PennsylvaniaRESPONSIBILITIES/TASKS: Restoration Estimators work with owners, adjusters, and Project Managers after traumatic events such as a fire or flood to clean up and repair damage to residential and commercial property. Whether property damage is caused by water, fire, smoke, storms or other disasters, we deliver on our promise to deliver excellence, expertise and a customer experience that is second to none.
Assistant Mitigation Estimator Paul Davis RestorationAssistant Mitigation EstimatorBeaver Falls, PennsylvaniaCommunicate back and forth with FAST, carriers, TPA’s, department managers, homeowners and adjusters on estimate revisions that need done and on any justification for estimate line items - this all needs done within the allotted time frames Upload all final documents provided by the PM to the appropriate online platform Participate in weekly meetings with Mitigation Managers & Project Managers as needed to discuss job progressions, job budgeting and any other job specific scenarios and concerns Follow up with insurance carriers, tpas, adjusters, and customers regarding payment for outstanding balances Review job status reports for completed jobs prior to submittal for job closing and sign off on checklists/audits. Work directly with the mitigation Project managers on scopes of work Review scopes provided by Project Managers from multiple platforms/documents Upload initial job documents provided by the Project Managers to the appropriate online platform(s) & within the timeframes allotted Be able to write “temporary” estimates or “work order” estimates to produce payouts for Project managers, laborers, technicians, subcontractors and/or venders.
Technical Coaching Lead Representative - SHS - Evernorth - Remote The Cigna GroupTechnical Coaching Lead Representative - SHS - Evernorth - RemotePARemote$22–$33 / hourThese states include: Alabama, Alaska, Arizona, Arkansas, Delaware, Florida, Georgia, Hawaii, Idaho, Iowa, Kansas, Maryland, Massachusetts, Michigan, Nebraska, Ohio, Pennsylvania, Texas, Utah, Vermont, and Washington State. If you will be working at home occasionally or permanently, the internet connection must be obtained through a cable broadband or fiber optic internet service provider with speeds of at least 10Mbps download/5Mbps upload.
Senior Medical Stop Loss Underwriter Highmark IncSenior Medical Stop Loss UnderwriterPAActively pursuing a professional designation related to the healthcare industry and be willing to complete one course within twelve months in either Life Office Management Association (LOMA) Certified Employee Benefit Specialist (CEBS), or America"s Health Insurance Plans (AHIP). Analyzes data such as financial conditions of the organization, participation percentage, type of industry, characteristics of employee groups, or past claim experience to determine what benefits can be offered and to set the rates.
Insurance Account Position - State Farm Agent Team Member Brendan Garvey - State Farm AgentInsurance Account Position - State Farm Agent Team MemberAliquippa, PAFull timeAs our Insurance Account Position - State Farm Agent Team Member, your knowledge of insurance products and industry trends equips you to communicate directly with customers, identify their needs, and market products or services that maximize value. If you are energetic, goal-oriented, and sales-minded, we are excited to harness your talents in this rewarding opportunity to build your career.
Commercial Counsel Sargent ElectricCommercial CounselPittsburgh, PAFull timeWHAT YOU'LL DO: Serve as a legal advisor for three U.S. operating companies engaged in the electrical construction, telecommunication, power, utilities, infrastructure, mission critical, and renewable energy markets, providing strategic and day-to-day commercial legal support across the full project lifecycle, including project development, contracting, execution, change management, claims, disputes, and closeout. ADDITIONAL QUALIFICATIONS: Experience advising business and project teams - whether in-house or in private practice - on legal and commercial risk allocation, contract administration, claims, disputes, and project execution issues in the electrical construction, telecommunications, power, utilities, infrastructure, mission critical, renewable energy, or other complex project-based businesses.