- Corewell Health (Grand Rapids, MI)
- This position will support our non - contracted provider post claim appeals submitted to the health plan. Job Summary Responsible for the analysis, research ... of the member appeal and fair hearing review processes for all non - Medicare products to thoroughly investigate appeal requests, leveraging critical thinking… more
- Molina Healthcare (MA)
- …Relations staff are the primary point of contact between Molina Healthcare and contracted provider network. In partnership with Director, manages and coordinates ... staff including hiring, training and evaluating performance. * Assists with ongoing provider network development and the education of contracted network… more
- Molina Healthcare (Bowling Green, KY)
- …and reports to meet internal/external standards. * Assists with ongoing enterprise-wide provider network development and the education of contracted network ... and strategic goals are realized. * Ensures appropriate cross-departmental communication of provider network initiatives and contracted network provider … more
- AmeriHealth Caritas (Detroit, MI)
- …its contracted and non - contracted providers across Medicaid, Medicare , and Exchange products. This role ensures provider information is correctly ... **Role Overview:** The Provider Network Operations Data Analyst plays a key...Access (formulas, pivot tables, charts/graphs). + Strong analytical skills ( non -IT focused) As a company, we support internal diversity… more
- Surgery Care Affiliates (Boise, ID)
- …website, and phone to collect payments. + Manages contracted and non - contracted , Government, Commercial, Medicare Advantage, Workers Compensation, and ... metrics and goals + Effectively and independently manages second level reimbursement issues, contracted and non - contracted denials and appeals. + This is… more
- State of Colorado (Centennial, CO)
- Lead Mid-Level Provider / Nurse Practitioner - Marvin Foote Youth Services Center Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/5192924) Apply ... Lead Mid-Level Provider / Nurse Practitioner - Marvin Foote Youth Services...Youth Services (DYS) provides a continuum of residential and non -residential services that encompass juvenile detention, commitment, and parole.… more
- State of Colorado (Denver, CO)
- Lead Mid-Level Provider / Nurse Practitioner - Gilliam Youth Services Center - Denver Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/5110624) ... Apply Lead Mid-Level Provider / Nurse Practitioner - Gilliam Youth Services Center...Youth Services (DYS) provides a continuum of residential and non -residential services that encompass juvenile detention, commitment, and parole.… more
- Molina Healthcare (OH)
- … Services staff are the primary point of contact between Molina Healthcare and contracted provider network. They are responsible for the provider training, ... of the Representative during these visits is to proactively engage with the provider and staff to determine, for example, non -compliance with Molina… more
- Molina Healthcare (Jackson, MI)
- …Relations staff are the primary point of contact between Molina Healthcare and contracted provider network. They are responsible for network management including ... of the Representative during these visits is to proactively engage with the provider and staff to determine, for example, non -compliance with Molina… more
- University of Michigan (Ann Arbor, MI)
- … Enrollment Specialist Apply Now **Job Summary** Coordinates employed and contracted billable provider 's and facilities initial enrollment and re-credentialing ... process with third party payers, out of state Medicaid and Medicare . Includes NPI management for facilities. Maintains database for hospital, group and billing… more
- University of Southern California (Alhambra, CA)
- …coordinator, timely completion of all tasks, from the plan of care. Provide coordination of care such as schedule patients' appointments, arrange transportation, ... pharmacy, behavioral health, field team, office staff, and facility staff. 11. Completes Medicare One Day Stay forms timely. 12. Completes disposition form for … more
- University of Southern California (Alhambra, CA)
- …if applicable. Communicate with providers and team regarding out-of-network issues, assess contracted and non - contracted payer issues, and document outcomes ... balances. Conduct all transactions appropriately and consistently, and complete Medicare Secondary Questionnaire accurately with the patient or patient's… more
- University of Southern California (Alhambra, CA)
- …- Collections Follow-up and collect on accounts for all payors, including Medicare , Medi-Cal, commercial, guarantor, and other contracted payors. Primary ... Works as a member of the billing team to provide smooth operational flow resulting in optimum customer (internal/external)...Managed Care contracts (ie, PPO, HMO, EPO, POS, Medi-Cal, Medicare , etc.). Applies knowledge of Cerner, AIDX/GE and other… more
- University of Southern California (Las Vegas, NV)
- …treatment for a specified patient population. Stresses health education and preventive medicare care, where appropriate. + 2. Takes adequate histories of patients ... for patients with multiple low risk hospitalizations. + 15. Works with contracted utilization management company to discuss patients with complex diagnosis and/or… more
- Fallon Health (Worcester, MA)
- …improving health and inspiring hope, we strive to be the leading provider of government-sponsored health insurance programs-including Medicare , Medicaid, and ... Under the direction of the Manager of Prior Authorization, communicates with contracted and non - contracted facilities/agencies/providers to collect pertinent… more
- New York State Civil Service (Utica, NY)
- …Annually Employment Type Full-Time Appointment Type Permanent Jurisdictional Class Non -competitive Class Travel Percentage 0% Workweek Other (see below) "Other" ... not limited to:* Assess individual and family needs, strengths, and limitations;* Provide individual, group and family therapy, as well as crisis intervention;*… more
- New York State Civil Service (Queens Village, NY)
- …Annually Employment Type Full-Time Appointment Type Permanent Jurisdictional Class Non -competitive Class Travel Percentage 0% Workweek Other (see below) "Other" ... eligibility for full and unconditional participation in the Medicaid and Medicare programs. Failure to maintain certification and Medicaid/ Medicare eligibility… more
- New York State Civil Service (Utica, NY)
- …Annually Employment Type Full-Time Appointment Type Permanent Jurisdictional Class Non -competitive Class Travel Percentage 0% Workweek Other (see below) "Other" ... Performs other job-related duties as assigned. Minimum Qualifications For permanent, non -competitive appointment under the Civil Service Hiring for Emergency Limited… more
- New York State Civil Service (Ovid, NY)
- …Annually Employment Type Full-Time Appointment Type Permanent Jurisdictional Class Non -competitive Class Travel Percentage 0% Workweek Other (see below) "Other" ... reports and records electronically and/or physically as appropriate.* May provide clinical supervision to licensed, paraprofessional, and direct care personnel… more
- Surgery Care Affiliates (Boise, ID)
- … relations representatives. + Has thorough knowledge of ASC Allowable procedures. + Handles contracted and non - contracted ; HMO, PPO, EPO, POS, Worker's Com., ... reimbursement issues. + Effectively and independently handles second level reimbursement issues, contracted and non - contracted denials for serviced before… more