- 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
- 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
- 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
- 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
- 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