- Novo Nordisk Inc. (Plainsboro, NJ)
- …& Contracting, and other field and home office stakeholders. External relationships include Managed Care & Medicare customers, Market Access and System Vendors. ... with external source for loading and scrubbing of rebate claims data Works with external vendor and customer to resolve data issues Provides support for… more
- AIG (Atlanta, GA)
- …work and live. We encourage colleagues to give back to the causes they care most about, supporting these efforts through our Volunteer Time Off and Matching Grants ... range of products to customers through a diversified, multichannel distribution network. Claims Our claims professionals support AIG policyholders through some… more
- CVS Health (Woonsocket, RI)
- …and NCPDP standards + 3+ years of analytical experience within pharmacy, healthcare, managed care , or related field + Attention to detail, strong drive ... of your health. This purpose guides our commitment to deliver enhanced human-centric health care for a rapidly changing world. Anchored in our brand - with heart at… more
- Molina Healthcare (Los Angeles, CA)
- …analytical, problem solving, decision making and people management skills. **Preferred Experience** Managed Care industry experience. 10+ years of IT Contract ... **Job Summary** The position will oversee and manage the Vendor Management team responsible of managing and coordinating the vendor activities between contracted… more
- Amneal Pharmaceuticals (Bridgewater, NJ)
- …As a Manager, this role will be responsible for leading and supporting the Managed Care claims processing, contract maintenance, formulary and data ... and SOP's that govern the processing of all customer managed care claims (such as...vendor estimates and accruals. + Review and approve managed care rebate payments per the DOA.… more
- LA Care Health Plan (Los Angeles, CA)
- …evaluate, and deploy solutions which contribute to the accurate receipt, loading, and exchange of claims data managed by the Claims Data & Support Services ... Program Manager II (ALD) Job Category: Administrative, HR, Business Professionals Department: Claims Data and Support Services Location: Los Angeles, CA, US, 90017… more
- VNS Health (Manhattan, NY)
- …opportunities What You Will Do + Assists the Manager in analyzing and validating managed care claims and comp grids against provider contracts, member ... supporting data as required. + Conducts analysis of delegated vendor claims data to test affordability, support...statistics required Work Experience: + Minimum of two years managed care claims analysis experience… more
- Humana (Oklahoma City, OK)
- …interactions with Humana's Oklahoma Medicaid plan + Ensure compliance with Oklahoma's managed care contractual requirements for provider relations, such as ... Southeast Oklahoma + 2 or more years of health care or managed care experience...care experience working with providers (eg, provider relations, claims education) + Experience working with or in health… more
- UNC Health Care (Goldsboro, NC)
- …including NC laws, Medicaid, Medicare, Liability, Worker's Compensation, HMO/PPO and Managed Care regulatory requirements, compliance guidelines and coordination ... Reviews PFS email daily and routes correspondence to our vendor ACI's workqueue or to Customer Service. 16. Audit...on payor escalation spreadsheets and will send to appropriate payor/ Managed Care since assistance is needed to… more
- Molina Healthcare (Columbus, OH)
- …healthcare vendor , commercial health insurance company, large physician practices, managed care organization, etc.) + Proficiency with Microsoft Excel ... utilized in medical coding/billing (UB04/1500 form) + Demonstrated understanding of key managed care concepts and provider reimbursement principles such as risk… more
- Point32Health (Canton, MA)
- …perform in the position. + Accounting, finance, or banking experience is preferred, managed health care operations experience is a plus **SKILL REQUIREMENTS:** ... a leading health and wellbeing organization, delivering an ever-better personalized health care experience to everyone in our communities. At Point32Health, we are… more
- Fallon Health (Worcester, MA)
- …related to fraud and general risk management.Medical claim terminology, coding, and managed care expertise or clinical background. + Strong attention to ... our Program Integrity efforts. + Oversee any external FWA vendor (s) and make enhancement to the tool, reporting and...and capture results. + 5-8 years of related health care claims auditing experience in a complex… more
- Hoffman Construction Company (Portland, OR)
- …paid time off, a generous retirement program and highly competitive pay. We take care of each other by offering free primary healthcare to our employees and their ... for managing all aspects of the owner, subcontractor, and vendor contracts for large scale construction projects. This role...mitigate them. + Address and resolve any disputes or claims related to contracts in a timely manner. +… more
- Novo Nordisk (Plainsboro, NJ)
- …& Contracting, and other field and home office stakeholders. External relationships include Managed Care & Medicare customers, Market Access and System Vendors. ... with external source for loading and scrubbing of rebate claims data + Works with external vendor and customer to resolve data issues + Provides support… more
- UCLA Health (Los Angeles, CA)
- …* Five or more years of experience with CMS processes in a Medicare or managed care environment * Must have 3-5 years of experience with Encounter submission ... be instrumental in maintaining and running processes/jobs for electronic claims and other EDI transactions. This will involve working...the health care model, capitation, and other managed care IPA and provider reimbursement methodologies… more
- Health First (Rockledge, FL)
- …Microsoft SQL Server, and Oracle. o Business knowledge of key managed care functions including specific knowledge of claims , enrollment, and premium business ... as well as PMO related project assignments. 8. Manage vendor relationship through communication with external vendor 's...ETL platforms and tools such as Azure Data Factory, Managed File Transfers, SFTP, PGP, and basic networking o… more
- Sharp HealthCare (San Diego, CA)
- …Administration** **Benefit Engine for Tapestry** 3+ years' experience with Delegated Managed Care Industry Standards and Compliance requirements and ... participation in Epic workgroups pertaining to: Claims , Membership, Benefits, Security, Data Migration, and Patient Access highly desired. **Required… more
- Point32Health (Canton, MA)
- …with presenting findings in a team environment. + Strong understanding of the managed care industry, preferably Medicare Advantage plans. + Experience in Product ... regulatory requirements and timelines. The Senior Manager works closely with claims , membership operations, clinical services, care management, customer… more
- Medical Mutual of Ohio (OH)
- …& Certifications** + **Strong knowledge of the MarketPlace and Medicare within a managed care insurance industry.** + **Knowledge of Centers for Medicare & ... Advisor for concurrent communication with providers regarding diagnosis documentation and claims submission).** + **Manages vendor agreements to ensure optimal… more
- HealthEdge Software Inc (Columbus, OH)
- …Practical understanding of the healthcare system with regards to Medicare, Medicaid, managed care , and commercial payment methodologies, payment integrity, and ... and maintenance of provider rate and/or claim editing provisions in a claims adjudication system and/or third-party vendor application. + Working knowledge… more
