- WellSense (Boston, MA)
- …taking the lead and promoting collaboration within Plan, as it relates to provider network maintenance. Manages territory inclusive of one or more of ... provider and internal Plan departments such as Provider Enrollment, Claims , Audit, Marketing, Customer Care...+ Analyzes operational issues with regard to territory and provider operations such that interrelationships among other… more
- Highmark Health (Boston, MA)
- … operations . (5%) + Communicates updated payer enrollment information including payer provider numbers to practice operations in a timely manner while ... **Company :** Allegheny Health Network **Job Description :** **GENERAL OVERVIEW:** Coordinates and facilitates the enrollment of Allegheny Clinic professional… more
- Intermountain Health (Boston, MA)
- …needs, specifically access and affordability. Acts as a strategic partner with provider offices and the organization to help build and manage aligned relationships. ... 2. Provides strategic input and network recommendations for Community Based Care, Specialty Based Care,...Steering Committee (PPSC). Participates in PPSC committee to determine provider status on networks. 4. Provides education to physician… more
- Evolent Health (Boston, MA)
- …through and maintaining trust. + Experience identifying and deploying initiatives across a provider network to drive clinical and financial outcomes. + Strong ... value contributed to the partnership. + Strong knowledge of health plan operations , care/utilization management, claims processing, value-based care, and the… more
- Evolent Health (Boston, MA)
- …of clinical operations in managed care, including quality management, outcomes, provider network , claims , financial management, care management policies, ... with other intake leaders across the organization, training and development, provider relations, member services, claims management and our implementation… more
- HomeSafe Alliance (Boston, MA)
- …we provide earlier visibility into upcoming moves and greater network throughput capacity-ensuring household goods shipments are picked up and delivered on ... of International Operations , for all shipments that may create inconvenience claims for HomeSafe. Formats and data requirements to be confirmed with DIOps. +… more
- Zurich NA (Boston, MA)
- AVP, Senior Operations Performance Lead 116994 What can go right when you can grow your career? Now is the time to move forward and make a difference. At Zurich, we ... insure 90% of the Fortune 500(R). Zurich strives to provide ongoing career development opportunities so you can reach...talent referral.** We are currently seeking an AVP, Senior Operations Performance Lead to join the USNA Operations… more
- Prime Therapeutics (Boston, MA)
- …experience in PBM system operations and experience developing and managing a pharmacy network . + Must be eligible to work in the United States without need for ... passion and drives every decision we make. **Job Posting Title** Dir Account Operations - Louisiana **Job Description** The Director Account Operations -… more
- State of Massachusetts (Boston, MA)
- …and Supports (OLTSS) Third Party Administrator contractual functions that relate to provider enrollment and credentialing, claims operations , appeals, ... OLTSS Third Party Administrator (TPA) contractual functions relating to provider enrollment and credentialing, claims operations...members/family to resolve issues that relate to the AFC/GAFC provider network and respond to requests for… more
- Prime Therapeutics (Boston, MA)
- …Responsibilities include answering incoming calls related to eligibility, benefits, claims and authorization of services from members or providers. Responsibilities ... of intake documentation into the appropriate systems. Overall expectations is to provide outstanding service to internal and external customers and strive to resolve… more
- Tufts Medicine (Lawrence, MA)
- …Profile** **Summary** This role focuses on activities related to revenue cycle operations such as billing, collections, and payment processing. In addition, this ... duties: Facilitates the reimbursement for clinical services provided to patients. Submits claims to health insurers, follows up with health insurers about submitted … more
- Tufts Medicine (Tyngsboro, MA)
- …Profile** **Summary** This role focuses on activities related to revenue cycle operations such as billing, collections, and payment processing. In addition, this ... duties: Facilitates the reimbursement for clinical services provided to patients. Submits claims to health insurers, follows up with health insurers about submitted … more
- Sedgwick (Boston, MA)
- …and to maintain relationships with internal and external customers, the provider / network and other members of the vendor community. **ESSTENTIAL ... and implements cost effective strategies promoting productive outcomes for Bill Review operations . + Ensures quality performance of the bill review product to… more
- Commonwealth Care Alliance (Boston, MA)
- …management functions with network strategy, vendor relationship management and claims processing. Works closely with provider relations on resolving ... with the Behavioral Health UM team the multiple clinical groups and provider partners in care management and care delivery, oversees the delegated entity… more
- Humana (Boston, MA)
- …such as claims processing, policy administration, and customer service operations . + **Technical Leadership:** Provide expert guidance and mentorship to ... operational efficiency, reduce manual processes, and improve accuracy in insurance claims processing, policy management, and other key areas. A strong background… more
- Tufts Medicine (Boston, MA)
- …Profile** **Summary** This role focuses on activities related to revenue cycle operations such as billing, collections, and payment processing. In addition, this ... duties: Facilitates the reimbursement for clinical services provided to patients. Submits claims to health insurers, follows up with health insurers about submitted … more
- Boston University (Boston, MA)
- …plan patients. Responsible for the gathering of all credentialing requirements for all provider network relations and assist with any follow-up required by ... primarily assist the Clinic Finance Manager with all insurance operations such as submission of claims , posting...of PPA/PDA, research and resolve claim denials from both in- network and out-of- network insurance companies, help to… more
- Cardinal Health (Boston, MA)
- …business rules. This position is responsible for guiding the patient and healthcare provider through the various process steps of their patient journey to therapy. ... manner. **_What Individualized Care contributes to Cardinal Health_** Clinical Operations is responsible for providing clinical specialties support and expertise… more
- RELX INC (Cambridge, MA)
- …and partners. + Maintaining a deep understanding of relevant industry data, including claims , provider data, and patient insights. + Performing all other duties ... of risk. Within our Healthcare vertical, our solutions focus on transforming operations and improving health outcomes across the healthcare industry. While our… more
- Cardinal Health (Boston, MA)
- …physician satisfaction as it relates to managed care contracts and operations . This position is responsible for administrative, strategic, business development, and ... of the business case, including oversight of managed care and reimbursement operations across Navista practices and business lines directly or in partnership with… more