- CVS Health (New York, NY)
- …short-term, and long-term goals. + 3+ years of analytical experience within pharmacy, healthcare, managed care , or related field + 3+ years of experience using ... short-term, and long-term goals. + 5+ years of analytical experience within pharmacy, healthcare, managed care , or related field + 5+ years of experience using… more
- Humana (Trenton, NJ)
- …and identify opportunities to for provider education. + Ensures compliance with Oklahoma's Managed Care Contractual requirements for provider relations, such as ... first** Humana Healthy Horizons in Oklahoma is seeking a Claims Research & Resolution Lead to lead a team...+ Experience with Oklahoma Medicaid. + Thorough understanding of managed care contracts, including contract language and… more
- FlexStaff (New York, NY)
- …plus) + Eight or more years of insurance experience within a healthcare or managed care setting (preferred) + Prior third party insurance billing experience, ... + Validates DRG grouping and (re)pricing outcomes presented by the claims processing vendor + Attends JOC meetings with providers as appropriate to assist… 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
- 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...experience required Work Experience: + Minimum of two years managed care claims analysis experience… more
- VNS Health (Manhattan, NY)
- …opportunities What You Will Do + Runs cost avoidance reports to analyze and validate managed care claims and comp grids against provider contracts, member ... Science, Mathematics or Statistics required Work Experience: + Minimum of three years managed care claims analysis experience. required + Experience in… more
- VNS Health (Manhattan, NY)
- …senior management on highly visible projects to understand business needs and challenges of managed care payors and to develop innovative solutions to meet those ... and to develop, design, plan, and deliver information systems solutions to meet managed care payor needs. + Functions as lead Business Systems Analyst… more
- VNS Health (Manhattan, NY)
- …+ Doctorate in Pharmacy (PharmD) required Work Experience: + Minimum of five years of Managed Care Pharmacy experience required + Experience in a managed ... Works under minimal supervision and fosters interdepartmental and external vendor collaboration. Compensation Range:$109,900.00 - $146,500.00 Annual What We Provide… more
- Ascendis Pharma (Princeton, NJ)
- …administration of rebate programs, including government rebates (eg, Medicaid, Medicare), managed care rebates, and commercial rebates. Ensure accurate ... formulary validation processes accurately and before payment deadlines, oversee payments of managed care and government rebates, and manage Market Access… more
- Molina Healthcare (New York, NY)
- …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
- Molina Healthcare (New York, NY)
- …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
- Humana (Trenton, NJ)
- …regarding own work approach/priorities and follows direction. Work is managed and often guided by precedent and/or documented procedures/regulations/professional ... interpretation. The Encounter Data Management Professional ensures data integrity for claims errors. The Encounter Data Management Professional work various tasks or… more
- Prime Therapeutics (Trenton, NJ)
- …is client facing, and acts as a strategic liaison between the business and vendor partners to ensure the Strategic Solutions roadmap is created, managed , and ... platforms and products + Experience using queries, thorough understanding of pharmaceutical claims data and general understanding of medical claims data; highly… more
- City of New York (New York, NY)
- …of public and commercial payors at the federal and state levels, and the evolution of managed care - Value-based care and Alternative Payment Models. - Price ... All-Payer Claims Databases, and other employer-led strategies promote high-value care - Civil rights and non-discrimination in healthcare - Medicaid policy and… more
- City of New York (New York, NY)
- …commercial payors at the federal and state levels, and the evolution of managed care . The regulation and financing of community-based organizations (CBO's) at ... Value-based care and Alternative Payment Models. Price transparency, All-Payer Claims Databases, and other employer-led strategies promote high-value care .… more
- CS Energy (Edison, NJ)
- …avoid legal actions. When needed work with legal teams on dispute resolutions and claims . + Assist Teams with training and development activities. + Hire and Train ... industry experience, with progressively greater responsibility + Successfully led and managed complex project or portfolios valued at $30+ million + Success… more