- R1 RCM (Salt Lake City, UT)
- …cash flows while reducing operating costs and enhancing the patient experience. As a Medicare Advantage Associate on our Revenue Recovery team, you will leverage ... your experience and expertise in complex Medicare Advantage payor methodology, payment screenings and experience maneuvering through various Patient Accounting… more
- WTW (Salt Lake City, UT)
- …The Lead Associate must be a subject matter expert in Medicare , Health Reimbursement Arrangements and the internal processes related to our business. This ... marketplace offers more than a traditional group health plan or group Medicare Advantage plan. For employers and plan sponsors the individual marketplace helps… more
- WTW (Salt Lake City, UT)
- …The Lead Associate must be a subject matter expert in Medicare , Qualified Health Plans, Health Reimbursement Arrangements and the internal processes related to ... Watson, providing relationship management and consultative services to clients. The Lead Associate will work within the Individual Marketplace and serve as the… more
- R1 RCM (Salt Lake City, UT)
- As Operations Associate I in our Revenue Recovery Practice, you will leverage your experience and expertise in complex Medicare Advantage payor methodology, ... systems to deliver quality work products to R1' s clients. The Medicare Advantage Analyst is primarily responsible for researching underpayments as they relate… more
- Conviva (Salt Lake City, UT)
- …part of our caring community and help us put health first** The Associate Director, Security Architecture will play a key role in implementing security architecture, ... to ensure the enterprise can achieve the enterprise security strategy. The Associate Director, Security Architecture will play a key role in implementing security… more
- Humana (Salt Lake City, UT)
- …caring community and help us put health first** The Consumer Service Operations Representative 2 represents the Dual Eligible Outreach Department by taking inbound ... providers regarding a variety of issues. The Consumer Service Operations Representative 2 performs advanced administrative/operational/customer support duties that… more
- Conviva (Salt Lake City, UT)
- …and help us put health first** The Revenue Cycle Manager (Onshore Operations ) oversees the onshore team responsible for the comprehensive management of revenue ... Professional and Payment Posting Auditors who work to ensure accurate financial operations and proper payment posting. The manager is also responsible for process… more
- Humana (Salt Lake City, UT)
- …ensure successful submission and reconciliation of encounter submissions to Medicaid/ Medicare . Ensures encounter submissions meet or exceed all compliance standards ... data, and develops tools to enhance the encounter acceptance rate by Medicaid/ Medicare . Looks for long term improvements of encounter submission processes. Decisions… more
- Humana (Salt Lake City, UT)
- …+ Minimum 1 year in a positionfocused on researching Regulatory Compliance for Medicare and/or Medicaid + Clinical Operations knowledge of Utilization Management ... . Responsibilities include: + Research new or emerging regulatory guidance ( Medicare and Medicaid): + Identify pertinent Utilization Management contractual and… more
- Humana (Salt Lake City, UT)
- …assignments. This position will focus on supporting Humana's senior-focused primary care operations . + Support growth and retention initiatives + Support review of ... law at a law firm or in-house health care organization + Experience in Medicare or similar regulatory work + Strong legal research, analytical, and writing skills +… more
- Humana (Salt Lake City, UT)
- …of our caring community and help us put health first** The Humana Enterprise Operations Enablement (EOE) - CPSS Data & Analytics - BI (Business Intelligence) team is ... data, data visualization and data science supporting Humana's Service Operations . The team is focused on converting data to...Apps and Power Automate + Knowledge of Medicaid and/or Medicare services + Advanced data analytics skills and reporting… more
- Humana (Salt Lake City, UT)
- …health first** This position will focus on supporting Humana's home health care operations , which includes CenterWell Home Health, one of the largest home health ... law topics, such as fraud, waste and abuse; State licensing and Medicare and Medicaid enrollment; internal and external audits; healthcare related contracting; or… more
- Humana (Salt Lake City, UT)
- …to make informed decisions + Support the daily management and operations of the department. Oversees utilization management functions which include timely ... team lead/SME or trainer/preceptor role + Health Plan experience + Previous Medicare experience a plus + MCG experience preferred **Work-At-Home Requirements** To… more
- Humana (Salt Lake City, UT)
- …user access in **Prisma portal** based on least privilege roles, and provide operations training and support, as needed. + Participate in a **24/7 on-call rotation** ... , leveraging **IaC automation** (Terraform) for efficient and secure cloud operations . + Proficiency in deploying and managing **NGFW policies** using **security… more
- Humana (Salt Lake City, UT)
- …community and help us put health first** The Senior Pharmacy Claims Operations Professional oversees the business processes and ensures accuracy for pharmacy point ... of sale transition adjudicated claims logic. The Senior Pharmacy Claims Operations Professional work assignments involve moderately complex to complex issues where… more
- Humana (Salt Lake City, UT)
- …information. Decisions are typically related to resources, approach, and tactical operations for projects and initiatives involving own departmental area. Requires ... an impact** **Required Qualifications** + A minimum of an Associate 's Degree + 5 or more years of experience...to a better quality of life for people with Medicare , Medicaid, families, individuals, military service personnel, and communities… more
- Humana (Salt Lake City, UT)
- …The Senior Data and Reporting Professional is responsible for supporting clinical operations through the delivery of dashboards, reports, and analysis. + Determine ... Derive observations and insights from metrics to support and improve clinical operations **Use your skills to make an impact** **Required Qualifications** +… more
- Humana (Salt Lake City, UT)
- …position will manage a Provider Activation Team within the Provider Network Operations area under Provider Process & Services. The Manager role is strategic ... Quality + Analyze business metrics and provide monthly review of assigned business operations + Act as a Strategic Partner with Market Leadership and Service… more
- Humana (Salt Lake City, UT)
- …Essentials** + 7+ years of experience in clinical strategy and/or HealthPlan operations + Professional clinical license (eg, MD, Registered Nurse or Pharmacist) or ... etc.), with evidence of deep understanding of healthcare data and health-systems operations + Excellent written and verbal communication skills, with ability to… more
- Humana (Salt Lake City, UT)
- …the Professional will work to identify areas of opportunity to optimize business operations that improve productivity and efficiency. This body of work will span ... + Ability to analyze metrics and apply measurable outcomes to improve operations (may include time studies, AHT, sales performance, quality, etc..) + Partner… more