- Claims Management at Humana in Meridian, Idaho, United States Job Description Description The Medical Director actively uses their medical background, experience, and judgement to make determinations whether requested services, requested level of care, and/or requested site of service should be authorized at the Appeals/Disputes level.
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Claims Manager
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Claims Manager
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Health2Business Boise, United StatesJob Description · Job DescriptionHealth2Business is seeking an experienced and dynamic Claims Manager to join our team. The Claims Manager will be responsible for overseeing all aspects of the claims process, ensuring accuracy and efficiency in claims processing. The ideal candid ...
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Patient Account Representative, Part Time
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SCA Health Meridian, United States Part timePatient Account Representative, Part Time - Treasure Valley Hospital · JOB_DESCRIPTION.SHARE.HTMLCAROUSEL_PARAGRAPH · JOB_DESCRIPTION.SHARE.HTMLMeridian, Idaho · Treasure Valley Hospital · Billing · Regular · Part-time · 1 · USD $19.00/Hr. · USD $28.00/Hr. · 34565 · Job Descripti ...
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Claims Adjuster
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Idaho State Job Bank Meridian, United StatesClaims Adjuster - General Liability / Bodily Injury Midwest Region at Sedgwick in Meridian, Idaho, United States Job Description Taking care of people is at the heart of everything we do, and we start by taking care of you, our valued colleague. A career at Sedgwick means experie ...
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Provider Payment Appeal Analyst I
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Norco, Inc Meridian, United StatesJob Description · Job DescriptionCompany Description · Founded in 1948, Norco is headquartered in Boise, Idaho and has more than 70 branches in Idaho, Montana, Oregon, Nevada, Washington, Utah and Wyoming. As a family and employee owned company we operate the nation's largest ind ...
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Employee Benefits Account Manager
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Commercial Lines Manager
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Mustard Seed Financial & Insurance Meridian, United StatesJob Description · Job DescriptionJoin Mustard Seed Financial & Insurance, a reputable insurance agency in Meridian, Idaho, as our Commercial Lines Account Executive. At Mustard Seed, we have built a strong foundation of trust and integrity with our clients, and we are seeking an ...
Medical Director Claims Management - Meridian, United States - Idaho State Job Bank
Description
Medical DirectorMedical Directors will learn Medicare and Medicare Advantage requirements and will understand how to operationalize this knowledge in their daily work.
Responsibilities The Medical Director's work includes computer-based review of moderately complex to complex clinical scenarios, review of all submitted clinical records, prioritization of daily work, communication of decisions to internal associates, and possible participation in care management.
The clinical scenarios predominantly arise from inpatient or post-acute care environments.Has discussions with external physicians by phone to gather additional clinical information or discuss determinations regularly, and in some instances these may require conflict resolution skills.
Some roles include an overview of coding practices and clinical documentation, grievance and appeals processes, and outpatient services and equipment, within their scope.
The Medical Director may speak with contracted external physicians, physician groups, facilities, or community groups to support regional market priorities, which may include an understanding of Humana processes, as well as a focus on collaborative business relationships, value based care, population health, or disease or care management.
Medical Directors support Humana values, and Humana's Bold Goal mission, throughout all activities.Required Qualifications + MD or DO degree + 5+ years of direct clinical patient care experience post residency or fellowship, which preferably includes some experience in an inpatient environment and/or related to care of a Medicare type population (disabled or >65 years of age).
+ Board Certified in an approved ABMS Medical Specialty with continued certification throughout employment. + A current and unrestricted license in at least one jurisdiction and willing to obtain additional license(s), if required. + No current sanction from Federal or State Governmental organizations, and ab To view full details and how to apply, please login or create a Job Seeker account
