- AIG (San Francisco, CA)
- Claims Complex Director - Healthcare Professional Liability (HPL) Join us as a Claims Complex Director to take on key responsibilities within ... an impact + This position will ensure high quality claims handling within the Healthcare Professional Liability...+ 7+ years of medical malpractice / professional liability complex claims and/or complex litigation… more
- Banner Health (Phoenix, AZ)
- …the effectiveness of risk mitigation strategies. 8. Oversees investigation and evaluation of complex claims and manages such claims through mediation and/or ... physicians. PREFERRED QUALIFICATIONS Strong negotiating skills and advanced knowledge of healthcare claims , risk management, quality management and performance… more
- CareFirst (Baltimore, MD)
- **Resp & Qualifications** We are seeking an experienced and dynamic Claims Operations Director to join our team and oversee our claims management ... will play a crucial role in enhancing the quality and efficiency of our claims processes. The Director of Claims Operations has overall responsibility… more
- Humana (Columbus, OH)
- …understand how to operationalize this knowledge in their daily work. The Medical Director 's work includes computer-based review of moderately complex to ... of our caring community and help us put health first** The Medical Director actively uses their medical background, experience, and judgement to make determinations… more
- Billings Clinic (Billings, MT)
- …regional affiliate locations to support risk functions as indicated by Risk Management Director . The Risk and Claims Specialist assists in coordination of the ... claims at the direction of the Risk Management Director and/or the Risk and Claims Coordinator...Risk & Claims Coordinator and Risk and Claims Analyst on complex issues. * Works… more
- Immigration and Customs Enforcement (Washington, DC)
- …Removal Operations (ERO), ICE Health Service Corps (IHSC), Office of Deputy Assistant Director for Healthcare Compliance, Office of Health Plan Management Unit ... to management, administration, or evaluation of public health programs. Healthcare management, finance or medical claims is...ICE Health Service Corps (IHSC), Office of Deputy Assistant Director for Healthcare Compliance, Office of Health… more
- Integra Partners (Troy, MI)
- …dynamic, proven Claims Examiner, with a specific background in the complex rehab technology (CRT) space. This role is responsible for real time support ... that exemplifies high energy and a passion for the healthcare business. To succeed, the individual will need to...Duties + Be prepared to appeal or correct CRT claims in compliance with Medicare, Medicaid, and commercial insurance… more
- CommuniCare Health Services Corporate (Charleston, WV)
- …leader in post-acute care for those that are chronically ill or have complex conditions. Our more than 150 skilled nursing, assisted living, independent living, ... growth, CommuniCare Health Services is currently recruiting for a Claims Validator / Biller to support our Central Billing...team, CBO cash posting team, Business Office Manager, Regional Director of Finance, MDS, Case Management, and others. The… more
- University of Maryland, Baltimore (Baltimore, MD)
- …CPT codes preferred. * Understand and have experience with large data sets, preferably healthcare claims databases such as Medicare or other health insurance ... * Claims Health Services Research Senior Programmer* *The University...Health in the UM-IHC and report directly to its Director working in close collaboration with other faculty, postdoctoral… more
- Prime Healthcare (Farmers Branch, TX)
- …trends and identify opportunities for process improvement and reimbursement optimization. + Complex Claims Management: identifies, trends, and owns portfolios of ... Outsourcing program across Revenue Cycle Management for all Prime Healthcare . The Corporate Director is responsible for... complex claims , including Third party claims , TDRG, Zero… more
- City of New York (New York, NY)
- … Director of OHSSA. This position will also serve as the inaugural Director of Healthcare Accountability, leading strategy and implementation for Local Law ... the Agency's Chief Medical Officer. The BEHS is the healthcare systems bureau of DOHMH. Our mission is to...routinely update their interpretation in accordance with a highly complex , rapidly evolving regulatory environment. - Stay informed of… more
- The Cigna Group (Seattle, WA)
- …of a Bachelor degree.** MBA or MHA preferred. + **3+ years Healthcare Provider Contracting and Negotiating experience involving complex Hospital/Health ... The ** Director , Provider Contracting** serves as an integral member...a local given territory. **DUTIES AND RESPONSIBILITIES** + Manages complex contracting and negotiations for fee for service and… more
- Molina Healthcare (Bellevue, WA)
- …Advanced knowledge of Excel + SQL knowledge preferred + Advanced knowledge of healthcare claims and claim processing from receipt through encounter submission. + ... including accurate and timely implementation and maintenance of critical information on claims databases. Validate data to be housed on databases and ensure… more
- Prime Healthcare (Ontario, CA)
- …including Claims and Customer Service, to provide guidance on complex Authorizations, Referrals, Denials and Appeals. + Integrates and coordinates services using ... and Company performance. Connect With Us! (https://careers-primehealthcare.icims.com/jobs/172723/corporate- director -of-clinical-utilization-management/job?mode=apply&apply=yes&in\_iframe=1&hashed=-336024306) FacilityPrime Healthcare Management… more
- Waystar (Atlanta, GA)
- **ABOUT THIS POSITION** This role reports to a Director , Product Management and work closely with User Experience team and Technology teams. The Product Manager will ... reports, and assessing strengths and weaknesses of competitors + Studying healthcare industry standards and staying up-to-date on industry changes and compliance… more
- Sanofi Group (Morristown, NJ)
- **Job title** : Global Medical Director , Evidence Generation - Insights and Strategy **Location:** Cambridge, MA, Morristown, NJ **About the Job** Sanofi's ambition ... best in class therapeutic solutions that address highest unmet needs. The Director for Medical Evidence Innovation in the Next-Gen Immunology franchise will serve… more
- Molina Healthcare (Columbus, OH)
- …years leadership/supervisory experience required * Progressive management experience to manage complex work systems and workflows required * Knowledge of pre-edit ... Access, Word and Excel * Knowledge and understanding of claims processing systems and medical claims *...position, please apply through the intranet job listing. Molina Healthcare offers a competitive benefits and compensation package. Molina… more
- Mount Sinai Health System (New York, NY)
- **Job Description** The Director , Hospital Contract Compliance will oversee the contract compliance program, ensuring the organization's contracts, specifically ... related to healthcare billing (hospital and professional), adhere to internal policies,...contract compliance monitoring, risk identification, and issue resolution. The Director will collaborate with various internal departments, including legal,… more
- Humana (Columbus, OH)
- … relies on medical background and reviews health claims . The Medical Director work assignments involve moderately complex to complex issues where ... understand how to operationalize this knowledge in their daily work. The Medical Director 's work includes computer-based review of moderately complex to … more
- Ascendis Pharma (Princeton, NJ)
- …and develop their skills. Ascendis Pharma is looking to hire an Associate Director , Rebate and Contract Operations to join our team. Responsibilities will include ... strong leadership, project management, and communication skills. As the Associate Director , Rebate and Contract Operations, you will be responsible for working… more