- Humana (Providence, RI)
- …our caring community and help us put health first** The Medicaid (PPS) Provider Hospital Reimbursement Analyst also known as a Senior Business ... the Pricer Business and System Support team responsible for administering complex Medicaid provider reimbursement methodologies. The associate will support… more
- Commonwealth Care Alliance (Boston, MA)
- …teams to monitor network performance against internal and regulatory benchmarks. * Ensure provider network compliance with CMS, state Medicaid agency, and NCQA ... 011230 CA- Provider Engagement & Performance Position Summary: The Director...contracting, or population health initiatives. * Prior work with hospital systems, large medical groups, and specialty care networks.… more
- Commonwealth Care Alliance (Boston, MA)
- …and strengthening relationships with the Commonwealth Care Alliance's (CCA) diverse provider community - including physician, hospital , behavioral health, ... Mentoring subject matter expert of the team + Managed Care experience (preferably Medicare/ Medicaid ) + Experience in health plan provider relations + Experience… more
- Humana (Providence, RI)
- …The Provider Contracting Executive initiates, negotiates, and executes physician, hospital , and/or other provider contracts and agreements. The Provider ... diverse scope and complexity ranging from moderate to substantial. The Provider Contracting Executive communicates contract terms, payment structures, and … more
- Brockton Hospital (West Bridgewater, MA)
- …on a pre-employment coding test. + Must be able to demonstrate knowledge of reimbursement (Medicare and Medicaid ) principles. + Must have knowledge of medical ... Signature Healthcare is Southeastern Massachusetts' premier local provider of quality, personalized medical services. We are comprised of the award-winning… more
- Beth Israel Lahey Health (Westwood, MA)
- …difference in people's lives.** Under the direction of the Manager, Provider Enrollment completes enrollment and health plan recredentialing applications. Maintains ... resource to providers, practice staff, BIDCO staff and health plan provider representatives concerning health care plan participation and status. Demonstrates… more
- Molina Healthcare (Worcester, MA)
- …modeling current and future contract rate proposals. + Research, analyze, and consult Medicaid and Medicare reimbursement methodologies, evaluate the impact of ... Business Intelligence tools (Medinsight, PowerBI), and Executive Dashboard. + Generate hospital performance analytics tools on a quarterly basis; develop reports on… more
- National Health Care Associates (Stafford Springs, CT)
- …personalized resident care plans and ensures the capture of clinical reimbursement for services provided. **Key Responsibilities:** + Determine Patient Driven ... prospective residents by assessing their nursing needs and determining appropriate clinical reimbursement levels + Complete and assure the accuracy of the MDS… more
- National Health Care Associates (Stafford Springs, CT)
- …for developing personalized resident care plans and the capture of clinical reimbursement for services provided. You will ensure the highest level of revenue ... looking for potential risks and/or changes that may affect reimbursement + May train, mentor and/or manage MDS Coordinators,...teams to ensure accurate data collection for assessments + Provide insights and ongoing education to facility staff and… more
- Humana (Providence, RI)
- …the operations of the Company's senior-focused primary care and home care businesses. + Provide guidance and advice with respect to a variety of issues related to ... + Medicare billing, enrollment, and conditions of participation rules + coding/ reimbursement and revenue cycle management + assisting in compliance reviews of… more