Maintain and apply knowledge on claims, customer service, provider demographic, contract/benefit configuration processes and related quality review processes Conduct appropriate preparation to ensure full understanding of training content and objectives prior to delivery Collaborate with appropriate resources, business partners, to facilitate development of training mater

Assist the provider / team with various care coordination activities in the nursing home Assist the provider / team with benefit determination associated with Medicare part A, part B, and part D benefits Collaborating with the primary APC and nursing facility to identify and respond to patient Change in Condition May assist the provider by completing DSTs, re assessing th

Travels to various assigned clinics to provide MA supervision, support and training in acquired clinics to support the integration process Provides supervision, support and serves as an on going consultant resource to the acquired clinic to ensure performance goals are met Engages the providers and staff as an early adopter and mentor of the changes being implemented in t

Reconcile payments from the bank to accounts balances in Specialty platform Develop relationships with payers to obtain remits and resolve root causes Assure that timely and accurate follow up if performed on any remittance issues Identify issues/trends and escalate to Supervisor / Manager when assistance is needed. Provide exceptional Customer service to internal and ext

Develop and maintain relationships with vendor partners Work closely with assigned business unit to support vendor hiring and placement Collaborate with other vendor managers to address gaps in staffing and client risk Effectively communicate with vendor partners to solve staffing issues Develop pipeline talent with multiple vendor partners to prepare for hiring Hold week

Position is for Senior Oracle RMB (Revenue Management/Billing) Developer to assist the team with maintenance and creating new solutions around our RMB technical environment. Position is technical in nature and candidate will coordinate with existing functional team members to develop custom RMB solutions. This candidate must have deep knowledge/expertise around RMB submod

Maintains MRI and CT authorization for both IDTF's. Both schedules are constantly influx with add ons and rescheduled appointments Work and track incoming imaging referrals by urgency and requested timeline Contact patients to schedule appointment for imaging exam Work Daily imaging report for pending appointments as well as following up with patients that have been added

Reviews audit errors and identifies coaching and training needs of Contract Services staff related to performance and quality statistics Acts as first level contact for escalated issues related to the Contract Services team Manage the daily work activities of all team members to include daily tasks and special projects, to maintain established service levels Provide initi

This role primarily provides medical care and management to members served by the Landmark program who request urgent visits to the IDT team during daytime and/or swing hours (8 hour shifts). This position also participates in new patient enrollment, post discharge visits, and gathering clinical information for medical necessity determinations for service requests. Dedica

Performs all nursing duties within the scope of a Licensed Vocational Nurse or Licensed Practical Nurse as required by state of employment (procedures, injections, EKGs, phlebotomy) Records patient care documentation in the medical record accurately and timely Reviews the patient record, chart, reports (including laboratory and x ray), and other pertinent information for

Assist the provider / team with various care coordination activities in the nursing home Assist the provider / team with benefit determination associated with Medicare part A, part B, and part D benefits Collaborating with the primary APC and nursing facility to identify and respond to patient Change in Condition May assist the provider by completing DSTs, re assessing th

Performs all duties within the scope of a Certified Medical Assistant (procedures, injections, diagnostic testing, phlebotomy) Coordinates healthcare screening results as directed by providers, company standards, and policies Travels with the mobile team to clinics and centralized locations to conduct screening clinics to support contracted physician network Rooms patient

Enter prescriptions and verify appropriate and accurate information Contact patients, pharmacists and doctor's offices to resolve claims issues Process prescriptions (from intake to order completion) Resolve customer issues; ensuring accurate information is provided This role is equally challenging and rewarding. You'll need to work within multiple computer systems simult

Interact with internal and external customers in a courteous manner in person and via telephone Complete check in and check out tasks Schedule new and existing patients Verify insurance and complete pre authorizations and/or precertification of procedures Answer back line telephone calls, re direct calls as appropriate, assist callers with questions or concerns and take m

COACHING Coach front line leaders and staff by asking questions, providing feedback, & teaching the use of lean tools, techniques, and principles to build a culture of problem solving Coaching on the following concepts/tools A3, PDSA, Huddles, Leader Standard Work, Standard Work, Kata, problem solving, culture, coaching, visibility boards, performance metrics (process vs.