31 benefits coding jobs found

CareFirst BlueCross BlueShield Resp & Qualifications PURPOSE: This role directly supports the Underwriting teams rating system by defining, designing, and developing system requirements. The position involves coordinating the design of subsystems, integrating total systems, and resolving program support deficiencies. The engineer will conduct independent technical investigations, perform elaborate data validation studies, and analyze system problems to develop effective innovation solutions. Responsibilities include designing, coding, testing, and documenting software applications. The role also requires gathering requirements, conducting advanced software analysis, and developing solutions. Additional duties involve integrating systems, designing architecture, and selecting suitable technologies and tools according to established project standards and procedures. This position collaborates closely with end-users and stakeholders to define system scope and...

Transamerica Job Family Actuarial About Us At Transamerica, hard work, innovative thinking, and personal accountability are qualities we honor and reward. We understand the potential of leveraging the talents of a diverse workforce. We embrace an environment where employees enjoy a balance between their careers, families, communities, and personal interests. Ultimately, we appreciate the uniqueness of a company where talented professionals work collaboratively in a positive environment - one focused on helping people look forward and plan for the best life possible while providing tools and solutions that make it easier to get there. Who We Are We believe everyone deserves to live their best life. More than a century ago, we were among the first financial services companies in America to serve everyday people from all walks of life. Today, we're part of an international holding company, with millions of customers and thousands of employees...

Open Systems Technologies Corporation Open Systems Technologies Corporation is a leader in the government contracting marketplace, providing Enterprise Security and Cloud Computing solutions to support large organizations. Our capabilities include supplying federal government entities and private businesses with software development, scientific and engineering technical assistance, systems integration, and enterprise security. Since its founding in 1996, OST has been committed to delivering high-quality, best-in-class results that bring added value to our clients while investing in our employees’ futures by providing exciting projects to work on, and robust benefits to include technical training and certifications, relocation assistance, and a 401K match with immediate vesting. Open Systems Technologies Corporation is looking for a Software Engineer to join a high-performing agile team that uses the Scaled Agile Framework (SAFe) methodology to support a nationally...

CareFirst BlueCross BlueShield Resp & Qualifications PURPOSE: We're hiring for a Manager, Data Analytics - Value-Based Care Reporting on the Health Economics and Reporting team at CareFirst! Purpose of the Manager, Data Analytics is to execute business objectives with data and ensure alignment with the vision of the company. Individual will organize the technology, processes and financial resources necessary to address the current and future analytics needs of the business. Provides thought leadership and acts as a subject matter expert in the designing and recommending of appropriate analytical approaches and methodologies. Provides management responsibility into data-driven insights that inform the business's strategic direction. We are looking for an experienced professional to live and work remotely from within the greater Baltimore/Washington metropolitan area. The incumbent will be expected to come into a CareFirst location periodically for meetings, training...

CareFirst BlueCross BlueShield Resp & Qualifications PURPOSE: Acts as an internal expert to ensure that as value-based reimbursement and medical policy models are developed and implemented. Provides advanced knowledge to support effective partnership with provider entities and guidance on the appropriate quality measure capture and proper use of CPT and ICD 10 codes in claims submissions. Utilizes extensive coding knowledge, combined with medical policy, credentialing, and contracting rules knowledge to help build the effective guides and resources for providers on the expected methodologies for billing and code submissions to maximize quality to maximize quality for FWA prevention. ESSENTIAL FUNCTIONS: Consults on proper coding rules in value-based contracts to ensure appropriate quality measure capture and proper use of CPT and ICD10 codes. Provides input on various consequences for different financial and incentive models. Supports to use of alternatives and...

CareFirst BlueCross BlueShield Resp & Qualifications PURPOSE: To support the prevention, reduction of and/or recuperation of losses to CareFirst through the clinical review of medical records and claims, resulting in the savings and/or recovery of funds. Responsible for providing clinical knowledge to the SI team to support both prepayment reviews and/or post-payment investigations. ESSENTIAL FUNCTIONS: Review of medical records and claims. Investigate potential fraud and over-utilization by performing complex medical reviews of claims and medical records. The claims may be in a pre or post payment environment. Provide a detailed but concise analysis to communicate findings about the ability to pay or deny a claim or claim lines using clinical and/or coding, billing, or reimbursement knowledge. Maintain appropriate records and supporting documentation regarding findings in accordance with departmental standards. Process all assigned claims or batch case reviews...

CareFirst BlueCross BlueShield Resp & Qualifications We are looking for an experienced professional in the greater Baltimore/Washington metropolitan area who is willing and able to work in a hybrid model. The incumbent will be expected to work a portion of their week from home and a portion of their week at a CareFirst location based on business needs and work activities/deliverables that week. PURPOSE: This role enables a seamless provider experience serving as a primary liaison with stakeholders within Health Services and across the company. Provides communication, education, issue/dispute resolution and support of managing all of CareFirst's contracted in-network providers including independent professional practices, health systems, hospitals, and ancillary providers across all lines of business. ESSENTIAL FUNCTIONS: RELATIONSHIP MANAGEMENT: Establishes and maintains relationships with providers and key stakeholders, by ensuring regular communications...

CareFirst BlueCross BlueShield Resp & Qualifications We are looking for an experienced professional in the greater Baltimore/Washington metropolitan area who is willing and able to work in a hybrid model. The incumbent will be expected to work a portion of their week from home and a portion of their week at a CareFirst location based on business needs and work activities/deliverables that week PURPOSE: This role will lead, guide, strategize and manage complex negotiations for larger top-tier provider-specific institutional, ancillary, and professional contracts. Key responsibilities include negotiating contract terms in accordance with regulatory requirements, analyzing financial data to evaluate implications across various business lines, while ensuring compliance with company policies and procedures, and coordinating with the Payment Transformation team to transition fee-for-service arrangements to value-based care. This role will also collaborate with various...

CareFirst BlueCross BlueShield Resp & Qualifications We are looking for an experienced professional in the greater Baltimore/Washington metropolitan area who is willing and able to work in a hybrid model. The incumbent will be expected to work a portion of their week from home and a portion of their week at a CareFirst location based on business needs and work activities/deliverables that week. PURPOSE: Responsible for planning and managing day to day activities regarding network development. Responsibilities include provider recruiting/contracting for commercial business and government programs, new networks, coordination with the Payment and Practice Transformation Team for value-based contracts, managing department-related RFP responses, tracking hospital-based practices and provider resignations, maintenance of participation agreements, reporting departmental metrics and overall management of all non-standard contract negotiations including single case...

CareFirst BlueCross BlueShield Resp & Qualifications PURPOSE: Acts as an internal expert to ensure that as value-based reimbursement and medical policy models are developed and implemented. Provides advanced knowledge to support effective partnership with provider entities and guidance on the appropriate quality measure capture and proper use of CPT and ICD 10 codes in claims submissions. Utilizes extensive coding knowledge, combined with medical policy, credentialing, and contracting rules knowledge to help build the effective guides and resources for providers on the expected methodologies for billing and code submissions to maximize quality for FWA prevention. ESSENTIAL FUNCTIONS: Consults on proper coding rules in value-based contracts to ensure appropriate quality measure capture and proper use of CPT and ICD10 codes. Provides input on various consequences for different financial and incentive models. Supports to use of alternatives and solutions to...

CareFirst BlueCross BlueShield Resp & Qualifications We are looking for an experienced professional in the greater Baltimore/Washington metropolitan area who is willing and able to work in a hybrid model. The incumbent will be expected to work a portion of their week from home and a portion of their week at a CareFirst location based on business needs and work activities/deliverables that week. PURPOSE: This role will lead, guide, strategize and manage negotiations for provider-specific institutional, ancillary, and professional contracts. Key responsibilities include negotiating contract terms in accordance with regulatory requirements, analyzing financial data to evaluate implications across various business lines, while ensuring compliance with company policies and procedures, and coordinating with the Payment Transformation team to transition fee-for-service arrangements to value-based care. This role will also oversee complex projects related to provider...

Apex Systems, Inc. Job#: 3020276 Job Description: JOB TITLE: Data Center Technical Operations Engineer I DURATION: 6 MONTHS LOCATION: ONSITE IN Frederick, MD PAY RATE: $25 - $35 HOURLY Job Description: The Data Center Technical Operations Engineer, Facility will be responsible for Data Center Engineering Operations within a Data Center including risk management and mitigation, corrective and preventative maintenance of critical infrastructure, vendor management and metric reporting. Responsibilities:* Responsible for the on-site management of shift technicians, senior shift technicians, sub-contractors and vendors, ensuring that all work performed is in accordance with established practices and procedures.* Establish performance benchmarks, conduct analyses, and prepare reports on all aspects of the critical facility operations and maintenance.* Work with IT managers and other business leaders to coordinate projects, manage capacity, and...

Apex Systems, Inc. Job#: 3020270 Job Description: JOB TITLE: Data Center Technical Operations Engineer I DURATION: 6 MONTHS LOCATION: ONSITE IN Frederick, MD PAY RATE: $25 - $35 HOURLY Job Description: The Data Center Technical Operations Engineer, Facility will be responsible for Data Center Engineering Operations within a Data Center including risk management and mitigation, corrective and preventative maintenance of critical infrastructure, vendor management and metric reporting. Responsibilities:* Responsible for the on-site management of shift technicians, senior shift technicians, sub-contractors and vendors, ensuring that all work performed is in accordance with established practices and procedures.* Establish performance benchmarks, conduct analyses, and prepare reports on all aspects of the critical facility operations and maintenance.* Work with IT managers and other business leaders to coordinate projects, manage capacity, and...

Apex Systems, Inc. Job#: 3020273 Job Description: JOB TITLE: Data Center Technical Operations Engineer I DURATION: 6 MONTHS LOCATION: ONSITE IN Frederick, MD PAY RATE: $25 - $35 HOURLY Job Description: The Data Center Technical Operations Engineer, Facility will be responsible for Data Center Engineering Operations within a Data Center including risk management and mitigation, corrective and preventative maintenance of critical infrastructure, vendor management and metric reporting. Responsibilities:* Responsible for the on-site management of shift technicians, senior shift technicians, sub-contractors and vendors, ensuring that all work performed is in accordance with established practices and procedures.* Establish performance benchmarks, conduct analyses, and prepare reports on all aspects of the critical facility operations and maintenance.* Work with IT managers and other business leaders to coordinate projects, manage capacity, and optimize...

American Red Cross Please use Google Chrome or Mozilla Firefox when accessing Candidate Home. By joining the American Red Cross you will touch millions of lives every year and experience the greatness of the human spirit at its best. Are you ready to be part of the world's largest humanitarian network? Join us-Where your Career is a Force for Good! Job Description: We provide Paid-Training - no prior medical experience required! Phlebotomy experience preferred. Joining The American Red Cross is like nothing else - it's as much something you feel as something you do. You become a vital part of the world's largest humanitarian network. Joining a team of welcoming individuals who are exceptional, yet unassuming. Diverse, yet uncompromising in unity. You grow your career within a movement that matters, where success is measured in people helped, communities made whole, and individuals equipped to never stop changing lives and situations for the better. When...

American Red Cross Please use Google Chrome or Mozilla Firefox when accessing Candidate Home. By joining the American Red Cross you will touch millions of lives every year and experience the greatness of the human spirit at its best. Are you ready to be part of the world's largest humanitarian network? Join us-Where your Career is a Force for Good! Job Description: We provide Paid-Training - no prior medical experience required! Phlebotomy experience preferred. Joining The American Red Cross is like nothing else - it's as much something you feel as something you do. You become a vital part of the world's largest humanitarian network. Joining a team of welcoming individuals who are exceptional, yet unassuming. Diverse, yet uncompromising in unity. You grow your career within a movement that matters, where success is measured in people helped, communities made whole, and individuals equipped to never stop changing lives and situations for the better. When...

American Red Cross Please use Google Chrome or Mozilla Firefox when accessing Candidate Home. By joining the American Red Cross you will touch millions of lives every year and experience the greatness of the human spirit at its best. Are you ready to be part of the world's largest humanitarian network? Join us-Where your Career is a Force for Good! Job Description: We provide Paid-Training - no prior medical experience required! Phlebotomy experience preferred. Joining The American Red Cross is like nothing else - it's as much something you feel as something you do. You become a vital part of the world's largest humanitarian network. Joining a team of welcoming individuals who are exceptional, yet unassuming. Diverse, yet uncompromising in unity. You grow your career within a movement that matters, where success is measured in people helped, communities made whole, and individuals equipped to never stop changing lives and situations for the better. When...

American Red Cross Please use Google Chrome or Mozilla Firefox when accessing Candidate Home. By joining the American Red Cross you will touch millions of lives every year and experience the greatness of the human spirit at its best. Are you ready to be part of the world's largest humanitarian network? Join us-Where your Career is a Force for Good! Job Description: We provide Paid-Training - no prior medical experience required! Phlebotomy experience preferred. Joining The American Red Cross is like nothing else - it's as much something you feel as something you do. You become a vital part of the world's largest humanitarian network. Joining a team of welcoming individuals who are exceptional, yet unassuming. Diverse, yet uncompromising in unity. You grow your career within a movement that matters, where success is measured in people helped, communities made whole, and individuals equipped to never stop changing lives and situations for the better. When...

Carter's, Inc. If you are a CURRENT Carter's employee, do not apply via this external application. Search "Browse Jobs" in Workday to apply internally. Love what you do. Carter's Careers. As a Sales Associate, you will be the first face of the brand for growing families. You'll congratulate new parents and grandparents, introduce them to our new baby essentials, help them prep for their first day of school, and all the big and little moments of their parenting journey. You'll join a welcoming and inclusive environment that values and optimizes skills and talents. What we love about Carter's: Carter's Inc. is the largest North American apparel retailer exclusively for babies and young children, encompassing Carter's, OshKosh B'gosh, Skip*Hop, and Little Planet brands. Carter's is the #1 most-purchased children's clothing brand.* We've become an industry leader by providing quality - from the first Original Bodysuit to the lasting careers we offer our team....

Carter's, Inc. If you are a CURRENT Carter's employee, do not apply via this external application. Search "Browse Jobs" in Workday to apply internally. Love what you do. Carter's Careers. As a Sales Associate, you will be the first face of the brand for growing families. You'll congratulate new parents and grandparents, introduce them to our new baby essentials, help them prep for their first day of school, and all the big and little moments of their parenting journey. You'll join a welcoming and inclusive environment that values and optimizes skills and talents. What we love about Carter's: Carter's Inc. is the largest North American apparel retailer exclusively for babies and young children, encompassing Carter's, OshKosh B'gosh, Skip*Hop, and Little Planet brands. Carter's is the #1 most-purchased children's clothing brand.* We've become an industry leader by providing quality - from the first Original Bodysuit to the lasting careers we offer our team....