136 to 150 of 6,999
Typically supports moderate to extreme complexity customers within multiple geographic areas Analyzing and interpreting various forms of utilization and healthcare data to identify potential areas for medical cost improvements via products, services and other market trends including ROI projections Participating in customer meetings as subject matter expert to present fin
Posted 2 days ago
Communicate with providers, patients, and pharmacy staff to obtain necessary clinical documentation and denial letters Interpret clinical documentation from providers and prior authorization denials Research clinical studies for points of argument for appeals Write and return assigned appeals to providers within two business days Communicate with payors to obtain timely d
Posted 2 days ago
Lead software development Agile scrum team Design, implement and maintain applications within all phases of the Software Development Life Cycle (SDLC) Develop, test, implement and maintain application software working with established processes Communicate effectively with engineers, product and business stakeholders Establish and maintain quality standards and follow eng
Posted 2 days ago
Provide claims expertise support by reviewing, researching, investigating, negotiating and resolving all types of claims as well as recovery and resolution for health plans, commercial customers, and government entities Analyze, identify trends and provide reports as necessary Ensure adherence to state and federal compliance policies, reimbursement policies and contract c
Posted 2 days ago
The Practice Performance Manager is responsible for program implementation and provider performance management which is tracked by designated provider metrics, inclusive minimally of 4 STAR gap closure and coding accuracy The person in this role is expected to work directly with care providers to build relationships, ensure effective education and reporting, proactively i
Posted 2 days ago
Applies knowledge/skills to activities that often vary from day to day Demonstrates a moderate level of knowledge and skills in own function Often acts as a technical resource to others in own function Requires little assistance with standard and non standard requests Solves routine problems on own Works with supervisor to solve more complex problems Proactively identifie
Posted 2 days ago
Create a positive experience and relationship with the member Help member set goals and develop a care plan to achieve those goals Proactively engage the member to manage their own health and healthcare Support the member to improve their wellbeing by staying out of the hospital, and attend regular visits to their primary physician Help the member engage with mental healt
Posted 2 days ago
Initiate technology project definition and planning activities Ensure cross value stream coordination and collaboration Serve as a thought leader to drive creative solutioning Work cross functionally to align strategy, methodology and execution Monitor delivery activities to ensure on scope, on time, on budget, on benefit and on quality delivery (5 ONs) Serve as an escala
Posted 2 days ago
Answer incoming phone calls from members and assist them by addressing inquiries, which may include benefit and eligibility information, billing and payment issues, customer material requests, physician assignments, authorization for treatment, and explanation of benefits (EOBs) Ask appropriate questions and listen actively to identify specific questions or issues while d
Posted 2 days ago
Coordinate and lead technology delivery to successful completion, operating within scope, budget, and schedule commitments Own end to end accountability for project/work stream delivery Facilitate consensus and decision making with product, vendor, and engineering Partner with stakeholders (internal and external) to align to strategy, plan, alignment, integration and visi
Posted 2 days ago
The Medical Assistant supports the Care team and its patients through patient care, clinical and administrative tasks including patient intake, receiving, and responding to patient phone calls, and documenting patient interactions The MA performs duties within their scope of practice delegated by, and under the supervision of, a provider or physician Organizes exam and tr
Posted 2 days ago
Responsible for taking calls and written communications from both customers and agents on all products serviced and respond in a professional, empathetic, and controlled manner using good judgement and listening skills Maintain knowledge and understanding of all systems and processes in order to effectively answer inquiries Obtain required information to give appropriate
Posted 2 days ago
Designs, writes, creates, and maintains curriculum and adoption materials, including multimedia deliverables, to lead in person and virtual instructor led training, self paced online learning, and other system adoption initiatives for a variety of audiences as assigned Incorporates instructional design best practices and adult learning theories to address a target audienc
Posted 2 days ago
Respond to and resolve, on the first call, customer service inquires and issues by identifying the topic and type of assistance the caller needs such as benefits, eligibility and claims, financial spending accounts and correspondence Help guide and educate customers about the fundamentals and benefits of consumer driven health care topics to select the best benefit plan o
Posted 2 days ago
Assist providers with examinations, minor surgical procedures and physicals May be required to perform certain tasks alone as instructed. These procedures may include but are not limited to Medical Duties Injections, sterile field set up, EKG, application of dressings and splints, PFT's, mass removal, flexible sigmoidoscopy, pap smears, pulse oximetry, orthostatic blood p
Posted 2 days ago
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