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The main purpose of this position is to expedite the recovery from commercial insurance to Medicare Part D when a COB audit has determined that Medicare should not have been the payer. ESSENTIAL DUTIES & RESPONSIBILITIES Meets, or exceeds, recovery goals. Generate invoice in payer to payer recoveries. Create and set up process with other payers. Ability to understand and explain COB rules. P
Posted Today
Processes plan document requests for open files. Utilizes and builds established client contact relationships. Accesses client systems to obtain necessary information and/or language documents. Maintains existing language database. Each team member checks the Group Portal, SharePoint and Product Support request for their specific clients. Each team member is responsible for assigning requests to t
Posted 1 day ago
Coordinates new employee orientation and electronic processing of paperwork. Responsible for assuring new hire onboarding is complete. Checks I 9 for accuracy and signatures, process paperwork for temporary employees, interns and new hires. Schedules pre screens and interviews with selected applicants. Enters disposition codes into ATS. Sends appropriate recruiting emails throughout the process. K
Posted 1 day ago
Investigates claims data to identify overpaid/incorrectly paid pharmacy claims and initiate the recovery of that money for our clients. The position requires extensive online research in clients' claims systems, internal research materials, internet resources and phone communications with members, employers, pharmacies, providers and other insurers. Handles administrative duties, including but
Posted 7 days ago
Opportunity with high growth healthcare organization
Posted 8 days ago
Communicates with Recovery Manager or assistant team manager regarding any training or job knowledge issues or any other concerns that may arise on the job Seeks to identify process improvements to increase the value of service provided to the client Performs other duties as assigned SKILLS & ABILITIES Strong analytical skills, possesses excellent skills in verbal and written communication Dem
Posted 8 days ago
JOB SUMMARY (All candidates must be available for onsite interview) Under the direction of the Manager of the Data Integrity Group, the ETL (Extract, Transform & Load) Developer will design, develop, test, and implement ETL and reporting programs for the Data Integrity Group to provide business solutions for The Rawlings Group. ESSENTIAL DUTIES & RESPONSIBILITIES Work with customers, manag
Posted 8 days ago
The Subrogation Analyst uses complex analytical skills to handle a large volume of Subrogation files and ultimately negotiate settlements on behalf of The Rawlings Group's health insurance clients. ESSENTIAL DUTIES & RESPONSIBILITIES Meet the goal of taking 16 inbound calls and making 32 (640/month) outbound calls daily. Maintain 100% quality of 550 700 file count. Maintain tickets daily.
Posted 9 days ago
All duties and responsibilities are to be performed in accordance with The Rawlings Company's policies, procedures, guidelines and contractual commitments and within governmental regulations. Perform analysis and verification of file openings from various sources and appropriate TRC systems' actions as necessary. Perform quality control analysis and take appropriate actions regarding data
Posted 11 days ago
The Subrogation Analyst uses complex analytical skills to handle a large volume of subrogation files and ultimately negotiate settlements on behalf of The Rawlings Group's health insurance clients. YOU WILL DO THIS BY..... Determining if a subrogation opportunity exists and taking steps to initiate recovery efforts. Negotiating recoveries with attorneys, insurance adjusters, and members. Devel
Posted 11 days ago
Internal & Client correspondence dealing with the correction/update of overpaid claims Monitor file submission process to ensure all files process timely Make adjustments to claims in our system and client systems to resolve claims that have been rejected Generate reports needed as part of this process Reconcile inventory between our system and our client system Respond to compliance audits fr
Posted 11 days ago
The Auditor is responsible for closing the required number of audits per day based upon the audit type with a 100% quality score. The Auditor investigates claims data to identify overpaid/incorrectly paid claims and initiates the recovery of that money for our clients. The position requires extensive online research in clients' claims systems, internal research materials, internet resources an
Posted 11 days ago
Work with customers, manager and other Software Developers to understand requirements for simple to complex business systems required by group. Work with other IT staff to develop technical specifications based upon functions specs as created. Develop or participate in development of systems using .Net architecture with Visual Studio 2010/2012 in C#. Follow typical systems development life cycle p
Posted 11 days ago
At Rawlings, our most important competitive advantage is our people. If you have a Bachelor's degree and/or MBA with three to five years of professional work experience , then this is the opportunity you are looking for. As an Operations Management Associate , you'll be part of a dynamic team, equipped to succeed, and empowered to develop your career. During training you will acquire prove
Posted 11 days ago
Possesses the ability to track files/requests/submissions through Centers for Medicare and Medicaid Services (CMS) processes; and creates documentation as required. Communicate and advise appropriate internal and external stakeholders on CMS matters including, but not limited to, lien negotiation efforts and/or general information. Analyze and process complex claims by investigating and gathering
Posted 11 days ago
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