- Novo Nordisk Inc. (Plainsboro, NJ)
- …& Contracting, and other field and home office stakeholders. External relationships include Managed Care & Medicare customers, Market Access and System Vendors. ... with external source for loading and scrubbing of rebate claims data Works with external vendor and customer to resolve data issues Provides support for… more
- Banner Health (Tucson, AZ)
- …APR-DRG; prior clinical or coding supervisory or management experience in managed care environment. Excellent communication, presentation and written skills ... you. Recognized nationally as an innovative leader in health care , Banner Plans & Networks (BPN) integrates Medicare and...offering remote and hybrid work settings. As a Director, Claims Recovery Unit, you will lead a small team… more
- Netflix (Los Angeles, CA)
- …issues, providing guidance on resolutions. + Oversee and monitor the TPA and managed care vendor activities, including compliance with claim management ... this role, you will support our Global Corporate and Production Casualty Claims , including workers' compensation, return to work, auto liability, and general… more
- CVS Health (Woonsocket, RI)
- …and NCPDP standards + 3+ years of analytical experience within pharmacy, healthcare, managed care , or related field + Attention to detail, strong drive ... of your health. This purpose guides our commitment to deliver enhanced human-centric health care for a rapidly changing world. Anchored in our brand - with heart at… more
- Molina Healthcare (WA)
- …Coordination of Benefits experience. + Experience with **_BPaaS solutions_** and Medicaid Managed Care programs. + Strong understanding of **_SQL and relational ... optimizing operational process designs, setting procedural standards, and overseeing vendor operations to ensure compliance with key performance indicators (KPIs)… more
- LA Care Health Plan (Los Angeles, CA)
- …evaluate, and deploy solutions which contribute to the accurate receipt, loading, and exchange of claims data managed by the Claims Data & Support Services ... Program Manager II (ALD) Job Category: Administrative, HR, Business Professionals Department: Claims Data and Support Services Location: Los Angeles, CA, US, 90017… more
- VNS Health (Manhattan, NY)
- …senior management on highly visible projects to understand business needs and challenges of managed care payors and to develop innovative solutions to meet those ... and to develop, design, plan, and deliver information systems solutions to meet managed care payor needs. + Functions as lead Business Systems Analyst… more
- MyFlorida (Tallahassee, FL)
- …waivers and home and community based waivers), administrative rules, coverage policies, managed care plan contracts, bill analyses, drug utilization review ... 21. This position is responsible for development of policy language for Statewide Medicaid Managed Care (SMMC) Plan Communications (ie, Dear Managed Care… more
- Humana (Indianapolis, IN)
- …(Indianapolis Metro Region) to provider offices and Humana locations.** + 2+ years of health care or managed care experience working with LTSS and HCBS ... education). + Experience working with or in a health care administration setting. + Understanding of healthcare claims...health providers and/or FQHCs is desired. + Understanding of managed care contracts, including contract language and… more
- Molina Healthcare (Grand Rapids, MI)
- …healthcare vendor , commercial health insurance company, large physician practices, managed care organization, etc.) + Proficiency with Microsoft Excel ... utilized in medical coding/billing (UB04/1500 form) + Demonstrated understanding of key managed care concepts and provider reimbursement principles such as risk… more
- Point32Health (Canton, MA)
- …perform in the position. + Accounting, finance, or banking experience is preferred, managed health care operations experience is a plus **SKILL REQUIREMENTS:** ... a leading health and wellbeing organization, delivering an ever-better personalized health care experience to everyone in our communities. At Point32Health, we are… more
- Fallon Health (Worcester, MA)
- …related to fraud and general risk management.Medical claim terminology, coding, and managed care expertise or clinical background. + Strong attention to ... our Program Integrity efforts. + Oversee any external FWA vendor (s) and make enhancement to the tool, reporting and...and capture results. + 5-8 years of related health care claims auditing experience in a complex… more
- Novo Nordisk (Plainsboro, NJ)
- …& Contracting, and other field and home office stakeholders. External relationships include Managed Care & Medicare customers, Market Access and System Vendors. ... with external source for loading and scrubbing of rebate claims data + Works with external vendor and customer to resolve data issues + Provides support… more
- Hoffman Construction Company (Portland, OR)
- …paid time off, a generous retirement program and highly competitive pay. We take care of each other by offering free primary healthcare to our employees and their ... for managing all aspects of the owner, subcontractor, and vendor contracts for large scale construction projects. This role...mitigate them. + Address and resolve any disputes or claims related to contracts in a timely manner. +… more
- UCLA Health (Los Angeles, CA)
- …* Five or more years of experience with CMS processes in a Medicare or managed care environment * Must have 3-5 years of experience with Encounter submission ... be instrumental in maintaining and running processes/jobs for electronic claims and other EDI transactions. This will involve working...the health care model, capitation, and other managed care IPA and provider reimbursement methodologies… more
- Molina Healthcare (Columbus, OH)
- …and strong system knowledge of QNXT and other state specific applications concerning Managed Care Enrollment. + Responsible for ensuring timely reconciliation of ... education and experience **Required Experience** 5-7 years Enrollment-related experience in Managed care or Medicare setting **Preferred Education** Graduate… more
- Henry Ford Health System (Troy, MI)
- …roadblocks and meet or exceed customer requirements and expectations. + Knowledge of medical claims data and managed care membership data. + Knowledge of ... with medical cost containment initiatives. Analyze medical and pharmacy claims to identify early signs of trends or other...years of progressive analytical experience in a healthcare or managed care /insurance related setting. + Minimum of… more
- Health First (Rockledge, FL)
- …Microsoft SQL Server, and Oracle. o Business knowledge of key managed care functions including specific knowledge of claims , enrollment, and premium business ... as well as PMO related project assignments. 8. Manage vendor relationship through communication with external vendor 's...ETL platforms and tools such as Azure Data Factory, Managed File Transfers, SFTP, PGP, and basic networking o… more
- Sharp HealthCare (San Diego, CA)
- …Administration** **Benefit Engine for Tapestry** 3+ years' experience with Delegated Managed Care Industry Standards and Compliance requirements and ... participation in Epic workgroups pertaining to: Claims , Membership, Benefits, Security, Data Migration, and Patient Access highly desired. **Required… more
- Point32Health (Canton, MA)
- …with presenting findings in a team environment. + Strong understanding of the managed care industry, preferably Medicare Advantage plans. + Experience in Product ... regulatory requirements and timelines. The Senior Manager works closely with claims , membership operations, clinical services, care management, customer… more
