- CVS Health (Oklahoma City, OK)
- …you all the way! This is a fulltime teleworker opportunity in Oklahoma. The Senior Claim Data Specialist handles end-to-end processes associated with claim data ... Fundamental Components: Reviews pre-specified claims or claims that exceed specialist adjudication authority or processing expertise. Applies medical necessity… more
- Novo Nordisk Inc. (Buffalo, NY)
- …Cardiometabolic Care Specialist I - $86,000 to $106,000 Cardiometabolic Care Specialist II - $113,000 to $138,000 Senior Cardiometabolic Care Specialist ... level impact Demonstrates understanding of the local payer market including Medicare , Commercial and Medicaid benefit designs, Payer Coverage, Prescription Coverage… more
- Novo Nordisk Inc. (Salinas, CA)
- …level impact Demonstrates understanding of the local payer market including Medicare , Commercial and Medicaid benefit designs, Payer Coverage, Prescription Coverage ... and legal requirements. Manages discretionary territory budget and marketing promotional program budget to support territory sales goals Demonstrates a clear and… more
- UPMC (Pittsburgh, PA)
- UPMC's Health Plan and WorkPartners are hiring an EAP Specialist for their LifeSolutions Clinical Services Team. This is a hybrid role that will work partially ... the direction of LS Clinical Director and/or the Medical Director, the EAP Specialist is responsible for providing the clinical services for the Employee Assistance … more
- Cleveland Clinic (Cleveland, OH)
- …healthcare organizations in the world. The Safety and Quality Patient Experience Specialist II (SQPE) leads safety, quality, and experience work at our Cleveland ... Clinic Main Campus. The Specialist coordinates and implements improvement initiatives. The focus of...organization. Build relationships with project teams, middle management, and senior sponsors. Coach smaller improvement teams to success with… more
- Medical Mutual of Ohio (Brooklyn, OH)
- …insured and self-funded group coverage, including stop loss, as well as Medicare Advantage, Medicare Supplement, and individual plans. **Provides expertise to ... related field. + 5 years of experience as a Sourcing Specialist or equivalent experience. **Professional Certification(s)** + Certified Purchasing Manager… more
- Cognizant (Albany, NY)
- **Job Title:** ** Sr . Product Specialist - QNXT Configuration (Remote)** **Job ID:** **66246221** **About the role** As a ** Sr . Product Specialist ** , you ... to design solutions, troubleshoot issues, and ensure compliance with Medicaid and Medicare requirements. **In this role, you will:** + Analyze, design, and build… more
- Waystar (Louisville, KY)
- **ABOUT THIS POSITION** While our Sr . Specialist Application Engineers are involved in multiple things throughout the Technology organization, primarily they are ... Client Success department in resolving issues relating to production processes. The Sr . Specialist Application Engineer is responsible for troubleshooting and… more
- Waystar (Lehi, UT)
- **ABOUT THIS POSITION** We're looking for a talented Sr . Specialist Application Engineer to join our Technology team. In this role, you'll collaborate with both ... to validate solutions + Communicate development progress daily to senior team members + Manage work items through internal...systems, and is connected to over 5K commercial and Medicaid/ Medicare payers. We are deeply committed to living out… more
- Waystar (Atlanta, GA)
- **ABOUT THIS POSITION** We are seeking a highly skilled and proactive Senior Specialist , Site Reliability Engineering (SRE) to help drive reliability, ... passion for automation, observability, and operational excellence. As a Senior Specialist , you'll work on complex reliability...systems, and is connected to over 5K commercial and Medicaid/ Medicare payers. We are deeply committed to living out… more
- BlueCross BlueShield of Tennessee (Chattanooga, TN)
- …and D claims to ensure accuracy, integrity, and compliance across the board\. Our ** Senior Ethics & Compliance Specialist ** role is where expertise meets purpose ... and policies to update compliance requirements\. + Leading the areas compliance program with the implementation of the approved monitoring workplan\. + Analyzing… more
- Waystar (Atlanta, GA)
- …We are looking for a talented and driven Site Reliability Engineering (SRE) Specialist to support our engineering team, which manages the infrastructure and services ... systems that ensure data integrity, availability, and performance. As an SRE Specialist , you'll work closely with engineering, product, and data teams to ensure… more
- UCHealth (Colorado Springs, CO)
- …physician. Verifies insurance eligibility for governmental insurance payors (ie Medicaid, Medicare , Tricare, etc.). May complete Medicare Secondary Payor ... a qualifying employer for the federal Public Service Loan Forgiveness (PSLF) program ! UCHealth provides employees with free assistance navigating the PSLF program… more
- Waystar (Louisville, KY)
- …hospitals and health systems, and is connected to over 5K commercial and Medicaid/ Medicare payers. We are deeply committed to living out our organizational values: ... family planning programs, including adoption assistance and fertility support + 401(K) program with company match + Pet insurance + Employee resource groups Waystar… more
- Commonwealth Care Alliance (Boston, MA)
- …Reporting to the Director, Claims Operations and Quality Assurance, the Claims Sr . Analyst plays a critical role in ensuring accurate, compliant, and timely ... reimbursements within the scope of MassHealth and Medicare Advantage programs. Under the direction of the Director...issues - including underpayments, overpayments, and disputes. The Claims Sr . Analyst serves as a subject matter expert on… more
- CVS Health (Raleigh, NC)
- …referred to the right specialists and OSH physicians have the needed support from specialist . You'll work with senior business and engineering leaders to lead a ... delivering a new model of care for adults on Medicare . By providing comprehensive and integrated care, we improve...offer an unmatched experience for our patients. As a Senior Product Manager, you will be a key leader… more
- Commonwealth Care Alliance (Boston, MA)
- 011230 CA-Provider Engagement & Performance **Position Summary:** The Senior Provider Relations Specialist is responsible for building, maintaining and ... to enhance provider satisfaction and member access to care. Reporting to the Senior , Director of Delegation Partnerships., the Senior Provider Relations Account… more
- CVS Health (Madison, WI)
- …pre-certification, and predetermination of covered benefits in the commercial, Medicare , and Medicaid environment. This Wheelchair DME consultant provides subject ... and correct application of Aetna policies and practices for commercial, Medicare , and Medicaid environments. ◾Proactively use data analysis to identify opportunities… more
- University of Southern California (Alhambra, CA)
- …between the CDM residing in the billing system and CDM management tools . The Senior RI Specialist shall ensure that the Chargemaster (CDM) is consistent with ... provided. This includes ensuring all annual updates required by Medicare and other third-party payers are up to date....and other third-party payers are up to date. The Senior RI Specialist delivers direction to the… more
- Molina Healthcare (NE)
- **Job Description** **Job Summary** The Sr Specialist , Member & Community Interventions oversees and implements new and existing clinical quality member ... and/or collaboratively with other departments. **Job Duties** + Acts as a lead specialist to provide project, program , and/or initiative related direction and… more
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