- CommuniCare Health Services Corporate (Blue Ash, OH)
- …Biller to support our Central Billing Office team. PURPOSE/BELIEF STATEMENT The position of Managed Care Claims Validator / Biller is responsible for ... accurate and timely filing of all managed care claims on their...protocols, timely filing rules, etc. + Attend, Participate, and/or Lead facility Educational In-services when appropriate. + Attend all… more
- Elevance Health (Mason, OH)
- …**Preferred Skills, Capabilities, and Experiences:** + 8-10 years of leadership and Managed Care experience, preferably in Medicare Advantage strongly preferred. ... **Rating/ Claims System Senior Advisor** **Location:** This position will...is designed to advance our strategy but will also lead to personal and professional growth for our associates.… more
- Elevance Health (Mason, OH)
- …or related field; minimum of 5 years' experience in broad-based analytical, managed care payor or provider environment; considerable experience in statistical ... organizations focusing efforts on explaining medical cost trends, lowering claims costs, and improving the quality of care...is designed to advance our strategy but will also lead to personal and professional growth for our associates.… more
- Elevance Health (Mason, OH)
- …or related field and a minimum of 3 years experience in broad-based analytical, managed care payor or provider environment as well as experience in statistical ... and/or Provider Contracting organizations, while focusing efforts on lowering claims costs, improving the quality of care ,...is designed to advance our strategy but will also lead to personal and professional growth for our associates.… more
- Elevance Health (Cincinnati, OH)
- …or related field; minimum of 5 years experience in broad-based analytical, managed care payor or provider environment; considerable experience in statistical ... Provides analytic support during complex provider negotiations. + Analyzes claims experience to identify cost of care ...is designed to advance our strategy but will also lead to personal and professional growth for our associates.… more
- Molina Healthcare (Covington, KY)
- …facilities, healthcare vendor, commercial health insurance company, large physician practices, managed care organization, etc.) + Proficiency with Microsoft ... 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 (Covington, KY)
- …Degree in Business Administration or related field or equivalent of 7 years+ in Managed Care or Medicare related field **Required Experience** + 10+ years ... customers including, but not limited to, IT; Finance; Actuarial, Claims , Call Centers and Utilization and Care ...operational experience with Managed Care and/or Medicare + 5+ years… more
- Elevance Health (Mason, OH)
- …the applicable medical policy and industry standards, accurately interpreting benefits and managed care products, and steering members to appropriate providers, ... process, the ability to interpret and apply member contracts, member benefits, and managed care products preferred. + Certification as a Case Manager is… more
- Elevance Health (Cincinnati, OH)
- …care setting preferred. + Minimum 2 years "telephonic" Case Management experience with a Managed Care Company preferred. + Managed Care experience ... the criteria._** The **Telephonic Nurse Case Manager I** is responsible for performing care management within the scope of licensure for members with complex and… more
- Molina Healthcare (Covington, KY)
- …to track progress and team productivity reporting. + Develop analysis and reporting related to Managed care data like Medical Claims , Pharmacy, Lab and HEDIS ... how to use reports. + Manage the design and lead development of retrospective HEDIS rate tracking, supplemental data...cleaning of data. + 7+ Years of experience in Managed Care Organization executing similar techno functional… more
- Molina Healthcare (Covington, KY)
- …and Target/Ranking Engine for all line of businesses. + Analysis and reporting related to Managed care data like Medical Claims , Pharmacy, Lab and related ... for business data issues as assigned by the team lead . + Analyze data sets and trends for anomalies,...cleaning of data. + 3-5 Years of experience in Managed Care Organization executing similar techno functional… more
- Elevance Health (Cincinnati, OH)
- …Manager is preferred. + Compact RN license preferred. + Minimum 2 years' experience in acute care setting. + Managed Care experience. + Ability to talk and ... The **Telephonic Nurse Case Manager II** is responsible for care management within the scope of licensure for members...as applicable. + Assists in problem solving with providers, claims or service issues. + Assists with development of… more