Case Manager - Registered Nurse
CVS Health- Full Time
- Junior (1 to 2 years)
Candidates must possess a minimum of one year of experience in US healthcare settings, with a strong focus on medical billing, coding (CPT, ICD-10), and case management, and demonstrate sound knowledge of HIPAA regulations. Applicants should also exhibit strong analytical skills, good judgment, attention to detail, efficiency in managing emails, excellent communication and problem-solving abilities, organizational skills, and an understanding of established processes with the capacity for good judgment.
The Case Manager will manage healthcare accounts, ensuring seamless claims processing and authorizations, oversee accurate and timely medical billing processes, including coding for services, review clinicals for case management and coordinate approvals, follow up on claims, resolve denials, and liaise with insurance providers, work closely with clinical, administrative, and financial teams to support seamless patient care and billing processes, utilize MS Office (Excel, PDF, Outlook) for reporting and documentation, and ensure compliance with billing policies and healthcare regulations.
Design and data support for government healthcare
A1M Solutions specializes in providing design, data, and policy-informed support for government healthcare programs, with a focus on serving disadvantaged populations. The company leverages expertise in government healthcare programs, data analysis, and policy/legislation to design effective business strategies and enhance digital service delivery, utilizing agile research and insights to untangle complex problems and generate thoughtful solutions.