Position Purpose: The Manager of Health Care Services plans, manages and oversees all utilization management, quality management, and potential quality Issues, including grievances, for all (currently 18) VA Community Based Outpatient Clinic nationally. Acts as the clinical liaison between Health Net, the VA Medical Center and subcontractors. Maintains clinical policies and procedures for each location. Manages processes related to potential quality issues and grievances. Provides supervision and technical guidance to the clinics' RN Managers (subcontracted staff) on clinical matters. Monitors and manages the medical records documentation, i.e., clinical reminders. Oversees the performance improvement program including preparation of contractually required reports. Trains staff on clinically related operational policies and procedures. Manages one Health Net associate. Functions as the liaison for clinical matters with the VA and subcontractors Education/Experience:...
Jan 24, 2021
Position Purpose: The Manager of Health Care Services plans, manages and oversees all utilization management, quality management, and potential quality Issues, including grievances, for all (currently 18) VA Community Based Outpatient Clinic nationally. Acts as the clinical liaison between Health Net, the VA Medical Center and subcontractors. Maintains clinical policies and procedures for each location. Manages processes related to potential quality issues and grievances. Provides supervision and technical guidance to the clinics' RN Managers (subcontracted staff) on clinical matters. Monitors and manages the medical records documentation, i.e., clinical reminders. Oversees the performance improvement program including preparation of contractually required reports. Trains staff on clinically related operational policies and procedures. Manages one Health Net associate. Functions as the liaison for clinical matters with the VA and subcontractors Education/Experience:...
Position Purpose: Manage department staff including hiring, performance management and career development to ensure alignment with defined goals. Manage programs and projects for particular technology product lines helping to drive the delivery of strategy efficiently and effectively. Optimize the effectiveness of all PMO standards and drive best practices throughout PMO. Work collaboratively with product owners to define the strategic priorities for focused delivery. Support effective reporting, KPI measures, and team performance. Lead multiple large, complex and enterprise wide technical and business oriented projects and programs for the Information Technology organization Mentor teams on best practices, process improvement, project and program management Drive strategy delivery, objectives and key results through value realization and metric tracking Own project and program portfolio for IT product lines through collaborative relationships Overshight to day...
Jan 23, 2021
Position Purpose: Manage department staff including hiring, performance management and career development to ensure alignment with defined goals. Manage programs and projects for particular technology product lines helping to drive the delivery of strategy efficiently and effectively. Optimize the effectiveness of all PMO standards and drive best practices throughout PMO. Work collaboratively with product owners to define the strategic priorities for focused delivery. Support effective reporting, KPI measures, and team performance. Lead multiple large, complex and enterprise wide technical and business oriented projects and programs for the Information Technology organization Mentor teams on best practices, process improvement, project and program management Drive strategy delivery, objectives and key results through value realization and metric tracking Own project and program portfolio for IT product lines through collaborative relationships Overshight to day...
Position Purpose: The Provider Network Manager manages provider networks for adequacy and access. Conducts high level negotiations and renegotiations of provider contracts. Monitors network adequacy and resolves provider claim issues. Provides regional input and maintenance of provider directory listings. Participates in monthly internal/external meetings involving network activity. Monitors areas credentialing process. Develops provider contracting strategy. Oversees network development and retention strategizing Oversees network problem resolution (Claims, UM, Etc.) Oversees network analysis for adequacy and recruitment targets Oversees provider contract negotiations Provides financial analysis for network development targets Education/Experience: Bachelor's Degree required; Master's degree preferred (MBA, MHA). Five to seven years in administration and/or negotiation of managed care contracts or provider recruitment. Government Security/Clearance/Citizenship...
Jan 23, 2021
Position Purpose: The Provider Network Manager manages provider networks for adequacy and access. Conducts high level negotiations and renegotiations of provider contracts. Monitors network adequacy and resolves provider claim issues. Provides regional input and maintenance of provider directory listings. Participates in monthly internal/external meetings involving network activity. Monitors areas credentialing process. Develops provider contracting strategy. Oversees network development and retention strategizing Oversees network problem resolution (Claims, UM, Etc.) Oversees network analysis for adequacy and recruitment targets Oversees provider contract negotiations Provides financial analysis for network development targets Education/Experience: Bachelor's Degree required; Master's degree preferred (MBA, MHA). Five to seven years in administration and/or negotiation of managed care contracts or provider recruitment. Government Security/Clearance/Citizenship...
Manages a team of Business Transformation professionals who are responsible for driving through training and enforcing department methodology including benchmarking, customer journey mapping, process flows and current state gap analysis, strategy mapping, financial optimization, organizational change management, governance, and implementation. Supports the Sr. Director in the strategic oversight of the department. Leverages superior knowledge of healthcare, WellCare, business improvement/transformation, organization change management, customer experience, and strategy, to provide training and enforcement of the eBT methodology tools and techniques. Ensures proposed business valuation maximizes impact with an emphasis on hard dollar Return on Investment (ROI) savings or cost avoidance scenarios Leads a team of professionals in guiding the business to achieve operational efficiency. Provides coaching and mentoring to develop Associates including career pathing within the department...
Jan 22, 2021
Manages a team of Business Transformation professionals who are responsible for driving through training and enforcing department methodology including benchmarking, customer journey mapping, process flows and current state gap analysis, strategy mapping, financial optimization, organizational change management, governance, and implementation. Supports the Sr. Director in the strategic oversight of the department. Leverages superior knowledge of healthcare, WellCare, business improvement/transformation, organization change management, customer experience, and strategy, to provide training and enforcement of the eBT methodology tools and techniques. Ensures proposed business valuation maximizes impact with an emphasis on hard dollar Return on Investment (ROI) savings or cost avoidance scenarios Leads a team of professionals in guiding the business to achieve operational efficiency. Provides coaching and mentoring to develop Associates including career pathing within the department...
Position Purpose: Serve as the claims payment expert for the Plan and as a liaison between the plan, claims, and various departments to effectively identify and resolve claims issues. Act as the subject matter expert for other Claims Liaisons. Analyze trends in claims processing issues and identify work process solutions Lead meetings with various departments to assign claim project priorities and monitor days in step processes to ensure the projects stay on track Assist in the writing work processes and continual auditing of the processes to ensure configuration, state mandates, benefits, etc. Review all Medicaid Bulletins for changes and updates and submit change requests (CRs) to update payment system. Audit check run and send claims to the claims department for corrections Identify any system changes and work notify the Plan CIA Manager to ensure its implementation Collaborate with the claims department to price pended claims correctly Document, track and...
Jan 20, 2021
Position Purpose: Serve as the claims payment expert for the Plan and as a liaison between the plan, claims, and various departments to effectively identify and resolve claims issues. Act as the subject matter expert for other Claims Liaisons. Analyze trends in claims processing issues and identify work process solutions Lead meetings with various departments to assign claim project priorities and monitor days in step processes to ensure the projects stay on track Assist in the writing work processes and continual auditing of the processes to ensure configuration, state mandates, benefits, etc. Review all Medicaid Bulletins for changes and updates and submit change requests (CRs) to update payment system. Audit check run and send claims to the claims department for corrections Identify any system changes and work notify the Plan CIA Manager to ensure its implementation Collaborate with the claims department to price pended claims correctly Document, track and...
Position Purpose: Processes and maintains eligibility information for routine individual and/or employer groups under direct supervision. Maintains accurate eligibility records for assigned line of business. Enters system eligibility data on a daily basis, including new enrollees, changes, and cancellations. Conducts periodic audits of group eligibility data. Reconciles group eligibility report to monthly statements. Responds to all written and telephone eligibility inquires from individuals or assigned employer groups. Researches information on subscribers to resolve problems and disputes. Maintains quality and production standards as outlined by the department. Assists with special projects. Education/Experience: High School Diploma or equivalent required. One year general work experience required. Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive...
Jan 20, 2021
Position Purpose: Processes and maintains eligibility information for routine individual and/or employer groups under direct supervision. Maintains accurate eligibility records for assigned line of business. Enters system eligibility data on a daily basis, including new enrollees, changes, and cancellations. Conducts periodic audits of group eligibility data. Reconciles group eligibility report to monthly statements. Responds to all written and telephone eligibility inquires from individuals or assigned employer groups. Researches information on subscribers to resolve problems and disputes. Maintains quality and production standards as outlined by the department. Assists with special projects. Education/Experience: High School Diploma or equivalent required. One year general work experience required. Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive...
Position Purpose: Design, build, test and maintain scalable and stable off the shelf application or custom built technology solutions to meet business needs. Act as a subject matter expert for Application Software developers and Engineers. Contribute to the entire implementation process including driving the definition of improvements based on business need and architectural improvements Meet with business partners to understand business needs Responsible for overall design of the solution Design, build and test applications Conduct root cause analysis and advanced performance tuning for complex business processes and functionality Education/Experience: Bachelor's degree in Computer Science, MIS, related field or equivalent experience. 3+ years of related experience. Healthcare experience strongly preferred, requires demonstrated understanding of business process as it relates to experience in the field. Hands on software quality assurance testing experience...
Jan 20, 2021
Position Purpose: Design, build, test and maintain scalable and stable off the shelf application or custom built technology solutions to meet business needs. Act as a subject matter expert for Application Software developers and Engineers. Contribute to the entire implementation process including driving the definition of improvements based on business need and architectural improvements Meet with business partners to understand business needs Responsible for overall design of the solution Design, build and test applications Conduct root cause analysis and advanced performance tuning for complex business processes and functionality Education/Experience: Bachelor's degree in Computer Science, MIS, related field or equivalent experience. 3+ years of related experience. Healthcare experience strongly preferred, requires demonstrated understanding of business process as it relates to experience in the field. Hands on software quality assurance testing experience...
Position Purpose: Perform various analysis and interpretation to link business needs and objectives for assigned function Support business initiatives through data analysis, identification of implementation barriers and user acceptance testing of various systems Identify and analyze user requirements, procedures, and problems to improve existing processes Perform detailed analysis on multiple projects, recommend potential business solutions and ensure successful implementations Identify ways to enhance performance management and operational reports related to new business implementation processes Coordinate with various business units and departments in the development and delivery of training programs Develop, share, and incorporate organizational best practices into business applications Diagnose problems and identify opportunities for process redesign and improvement Formulate and update departmental policies and procedures Serve as the subject matter...
Jan 20, 2021
Position Purpose: Perform various analysis and interpretation to link business needs and objectives for assigned function Support business initiatives through data analysis, identification of implementation barriers and user acceptance testing of various systems Identify and analyze user requirements, procedures, and problems to improve existing processes Perform detailed analysis on multiple projects, recommend potential business solutions and ensure successful implementations Identify ways to enhance performance management and operational reports related to new business implementation processes Coordinate with various business units and departments in the development and delivery of training programs Develop, share, and incorporate organizational best practices into business applications Diagnose problems and identify opportunities for process redesign and improvement Formulate and update departmental policies and procedures Serve as the subject matter...
Position Purpose: The Medical Management Support Specialist HNFS performs a variety of tasks to support Medical Management. The Specialist coordinates department and ITG participants for user acceptance testing; gathers information and drafts reports; and prepares the department and documentation for accreditation/reaccreditation evaluations. The Specialist ensures Policy and Procedures are current, assists managers and authors with the documentation process and ensures their compliance with the process and time lines. The Specialist is the main point of contact with internal and external customers for systems access, passwords and access problem resolution. Coordinates and performs UAT and System Testing; tracks and reports problems as required. Compiles information and prepares a variety of drafts and finished documents including schedules, presentations, charts, graphics, tables, and reports. Writes and edits processes and procedures. Assists others with creating...
Jan 20, 2021
Position Purpose: The Medical Management Support Specialist HNFS performs a variety of tasks to support Medical Management. The Specialist coordinates department and ITG participants for user acceptance testing; gathers information and drafts reports; and prepares the department and documentation for accreditation/reaccreditation evaluations. The Specialist ensures Policy and Procedures are current, assists managers and authors with the documentation process and ensures their compliance with the process and time lines. The Specialist is the main point of contact with internal and external customers for systems access, passwords and access problem resolution. Coordinates and performs UAT and System Testing; tracks and reports problems as required. Compiles information and prepares a variety of drafts and finished documents including schedules, presentations, charts, graphics, tables, and reports. Writes and edits processes and procedures. Assists others with creating...
Position Purpose: Assist in coordinating the day-to-day work function of the assigned claims unit, provide technical support to staff, and investigate, review and resolve complex issues Assist in reviewing investigating, adjusting and resolving complex claims, claims appeals, inquiries, and inaccuracies in payment of claims Oversee claims quality reviews for accuracy, document results and identify trends and systemic root cause analysis Assist in creating work flows for the department and support team members in understanding changes in work processes Primary contact for the team, for the plan and for other departments in researching, collecting background information and documentation, to address various issues. Assists supervisor to research and determine status of medical claims to assure billed dollars, claims aging, and pend values are consistent with contract provisions. Maintains records and reports as assigned Assist in meeting departmental production and...
Jan 20, 2021
Position Purpose: Assist in coordinating the day-to-day work function of the assigned claims unit, provide technical support to staff, and investigate, review and resolve complex issues Assist in reviewing investigating, adjusting and resolving complex claims, claims appeals, inquiries, and inaccuracies in payment of claims Oversee claims quality reviews for accuracy, document results and identify trends and systemic root cause analysis Assist in creating work flows for the department and support team members in understanding changes in work processes Primary contact for the team, for the plan and for other departments in researching, collecting background information and documentation, to address various issues. Assists supervisor to research and determine status of medical claims to assure billed dollars, claims aging, and pend values are consistent with contract provisions. Maintains records and reports as assigned Assist in meeting departmental production and...
Position Purpose: Conduct provider orientations as well as ongoing provider education to enhance provider relationships and ensure optimal customer satisfaction or CPARs results Educate providers on HNFS and TRICARE policies and procedures related to referrals, claims submission, credentialing documentation, web site education, and clear and legible report requirements Resolve provider issues by researching and analyzing provider contracts and system data to identify root cause Perform contracting duties as requested, including but not limited to submitting changes to provider related database information, sending contracts, and assisting in the completion of special projects Support network growth and development including the preparation of contract materials for provider recruitment projects Perform provider data audits and work with other groups to identify and correct provider data issues Perform health plan provider orientations and conduct ongoing...
Jan 20, 2021
Position Purpose: Conduct provider orientations as well as ongoing provider education to enhance provider relationships and ensure optimal customer satisfaction or CPARs results Educate providers on HNFS and TRICARE policies and procedures related to referrals, claims submission, credentialing documentation, web site education, and clear and legible report requirements Resolve provider issues by researching and analyzing provider contracts and system data to identify root cause Perform contracting duties as requested, including but not limited to submitting changes to provider related database information, sending contracts, and assisting in the completion of special projects Support network growth and development including the preparation of contract materials for provider recruitment projects Perform provider data audits and work with other groups to identify and correct provider data issues Perform health plan provider orientations and conduct ongoing...
Position Purpose: Design, build, test and maintain scalable and stable off the shelf application or custom built technology solutions to meet business needs Contribute to the entire implementation process for new applications and enhancements to existing applications Meet with business partners to understand business needs Contribute to overall solution design Responsible for build and test of applications Conduct root cause analysis and complex performance tuning Education/Experience : Bachelor's degree in Computer Science, MIS, related field or equivalent experience.2+ years of related experience. Healthcare experience a plus. Experience working with COBOL, JAVA, JSP, Supertool, PL/SQL, UNIX shell scripting, etc. Amisys, Facets or other claims management system experience a plus. Experience working with C#. Experience with Oracle or SQL Server. Experience with web services, messaging, and stored procedures preferred. Preferred Experience: Experience working...
Jan 20, 2021
Position Purpose: Design, build, test and maintain scalable and stable off the shelf application or custom built technology solutions to meet business needs Contribute to the entire implementation process for new applications and enhancements to existing applications Meet with business partners to understand business needs Contribute to overall solution design Responsible for build and test of applications Conduct root cause analysis and complex performance tuning Education/Experience : Bachelor's degree in Computer Science, MIS, related field or equivalent experience.2+ years of related experience. Healthcare experience a plus. Experience working with COBOL, JAVA, JSP, Supertool, PL/SQL, UNIX shell scripting, etc. Amisys, Facets or other claims management system experience a plus. Experience working with C#. Experience with Oracle or SQL Server. Experience with web services, messaging, and stored procedures preferred. Preferred Experience: Experience working...
Position Purpose: This is the advanced level of Customer Service Representative, responsible for handling customer service questions and issues. Associates at this level handle escalated issues that require greater product and service knowledge, and a higher level of customer service skill. The Customer Service Representative takes calls and processes transactions, such as referrals, authorizations, etc. The Customer Service Representative also resolves urgent and high profile problems from Beneficiary Counseling and Assistance Coordinators. Researches and responds to inquiries from beneficiaries and providers, such as benefits, claims, eligibility concerns, authorizations, etc. Handles escalated and high priority customer service issues. Resolves/de-escalates and/or escalates issues. Follows through with each issue to resolution by working with internal and external resources as needed. Receives calls for referrals and authorizations transactions, reviews...
Jan 20, 2021
Position Purpose: This is the advanced level of Customer Service Representative, responsible for handling customer service questions and issues. Associates at this level handle escalated issues that require greater product and service knowledge, and a higher level of customer service skill. The Customer Service Representative takes calls and processes transactions, such as referrals, authorizations, etc. The Customer Service Representative also resolves urgent and high profile problems from Beneficiary Counseling and Assistance Coordinators. Researches and responds to inquiries from beneficiaries and providers, such as benefits, claims, eligibility concerns, authorizations, etc. Handles escalated and high priority customer service issues. Resolves/de-escalates and/or escalates issues. Follows through with each issue to resolution by working with internal and external resources as needed. Receives calls for referrals and authorizations transactions, reviews...
Position Purpose: Process pended medical claims, verifying and updating information on submitted claims and reviewing work processes to determine reimbursement eligibility. Ensure payments and/or denials are made in accordance with company practices and procedures. Apply policy and provider contract provisions to determine if claim is payable, if additional information is needed, or if claim should be denied. Claims processing may be related to physician and hospital services, coordination of benefits (COB), high dollar, special pricing, refunds and/or adjustments on resubmitted claims. Research and determine status of medical related claims Review charges, access the computer system and use payment or denial codes within established department guidelines and standards Clarify health insurance coverage for coordination of benefits to process claims Maintain records, files, and documentation as appropriate Meet department production and quality standards...
Jan 20, 2021
Position Purpose: Process pended medical claims, verifying and updating information on submitted claims and reviewing work processes to determine reimbursement eligibility. Ensure payments and/or denials are made in accordance with company practices and procedures. Apply policy and provider contract provisions to determine if claim is payable, if additional information is needed, or if claim should be denied. Claims processing may be related to physician and hospital services, coordination of benefits (COB), high dollar, special pricing, refunds and/or adjustments on resubmitted claims. Research and determine status of medical related claims Review charges, access the computer system and use payment or denial codes within established department guidelines and standards Clarify health insurance coverage for coordination of benefits to process claims Maintain records, files, and documentation as appropriate Meet department production and quality standards...
Position Purpose: Serve as a liaison between the plan, claims, providers and various departments to effectively identify and resolve claims issues Audit check run and send claims to the claims department for corrections Identify any system changes and work notify the Plan CIA Manager to ensure its implementation Collaborate with the claims department to price pended claims correctly Document, track and resolve all plan providers' claims projects Collaborate with various business units to resolve claims issues to ensure prompt and accurate claims adjudication Identify authorization issues and trends and research for potential configuration related work process changes Analyze trends in claims processing issues and assist in identifying and quantifying issues and reviewing work processes Identify potential and documented eligibility issues and notify applicable departments to resolve Research the claims on various reports to determine if appropriate to...
Jan 20, 2021
Position Purpose: Serve as a liaison between the plan, claims, providers and various departments to effectively identify and resolve claims issues Audit check run and send claims to the claims department for corrections Identify any system changes and work notify the Plan CIA Manager to ensure its implementation Collaborate with the claims department to price pended claims correctly Document, track and resolve all plan providers' claims projects Collaborate with various business units to resolve claims issues to ensure prompt and accurate claims adjudication Identify authorization issues and trends and research for potential configuration related work process changes Analyze trends in claims processing issues and assist in identifying and quantifying issues and reviewing work processes Identify potential and documented eligibility issues and notify applicable departments to resolve Research the claims on various reports to determine if appropriate to...
Position Purpose: The Intake Representative I enters specific data/information from physicians' requests into a medical management authorization system, achieving required production quota/quality standards. Validates patient and medical provider demographic information including correct selection of a medical provider by specialty for healthcare service. Determines whether patients are eligible to receive health care benefits under the insurance program by determining the patients' status/eligibility the Primary Care Manager (doctor) type, and the appropriate referral/authorization path. Contacts medical provider offices by telephone, and makes confirmation calls to patients for all urgent requests. Uses sound judgment in making decisions in order to keep the referral/authorization process moving forward in accordance with contractual timeliness standards. Follows step-by-step instructions, including redirecting patients into the provider network for care, as...
Jan 20, 2021
Position Purpose: The Intake Representative I enters specific data/information from physicians' requests into a medical management authorization system, achieving required production quota/quality standards. Validates patient and medical provider demographic information including correct selection of a medical provider by specialty for healthcare service. Determines whether patients are eligible to receive health care benefits under the insurance program by determining the patients' status/eligibility the Primary Care Manager (doctor) type, and the appropriate referral/authorization path. Contacts medical provider offices by telephone, and makes confirmation calls to patients for all urgent requests. Uses sound judgment in making decisions in order to keep the referral/authorization process moving forward in accordance with contractual timeliness standards. Follows step-by-step instructions, including redirecting patients into the provider network for care, as...
Position Purpose: Interpret ABA claims, review medical records, and interpret medical policies to identify improper payments. Educate and advise staff on proper billing requirements, mitigate the impact of billing aberrancies to the program, triage reported fraud waste and abuse cases within the Applied Behavioral Analysis (ABA) program. Analyze and make determination of appropriate course of action for cases. Assist Program Integrity Investigators with Health Care Fraud Referrals concerning ABA providers. Assist in the development of policies, procedures, and educational materials to prevent loss of company assets. The ideal candidate will have experience in a managed care setting and experience with, or understanding of, the TRICARE program. Audit ABA claims by reviewing claims and medical records and researching program requirements, clinical guidelines, licensing board requirements and professional practices Draft, review, submit and track targeted educational letters and...
Jan 20, 2021
Position Purpose: Interpret ABA claims, review medical records, and interpret medical policies to identify improper payments. Educate and advise staff on proper billing requirements, mitigate the impact of billing aberrancies to the program, triage reported fraud waste and abuse cases within the Applied Behavioral Analysis (ABA) program. Analyze and make determination of appropriate course of action for cases. Assist Program Integrity Investigators with Health Care Fraud Referrals concerning ABA providers. Assist in the development of policies, procedures, and educational materials to prevent loss of company assets. The ideal candidate will have experience in a managed care setting and experience with, or understanding of, the TRICARE program. Audit ABA claims by reviewing claims and medical records and researching program requirements, clinical guidelines, licensing board requirements and professional practices Draft, review, submit and track targeted educational letters and...
Position Purpose: The Senior Director, Communications will oversee all communications including the development and implementation of a communications strategy and a broad and diverse range of business and marketing communications. This role will also direct and oversee the development and execution of statewide or federal branding and digital initiatives that help to transform and evolve the organization in a dynamic health care environment. In addition, the Senior Director, Communications will provide strategic counsel and a collaborative partnership for internal and external communications across a spectrum of platforms, and multiple departments in support of maintaining the corporate mission, brand, and goals. Ensure the integrity of the corporate mission and brand in written communication and digital. Oversee the execution of strategic federal, state, regional, or local public relations programs that support the organization's marketing goals and key messages. Lead...
Jan 20, 2021
Position Purpose: The Senior Director, Communications will oversee all communications including the development and implementation of a communications strategy and a broad and diverse range of business and marketing communications. This role will also direct and oversee the development and execution of statewide or federal branding and digital initiatives that help to transform and evolve the organization in a dynamic health care environment. In addition, the Senior Director, Communications will provide strategic counsel and a collaborative partnership for internal and external communications across a spectrum of platforms, and multiple departments in support of maintaining the corporate mission, brand, and goals. Ensure the integrity of the corporate mission and brand in written communication and digital. Oversee the execution of strategic federal, state, regional, or local public relations programs that support the organization's marketing goals and key messages. Lead...
Position Purpose: Oversee department staff including hiring, performance management and career development to ensure alignment with defined goals. Develop budgets and priorities, ensuring plans and resource allocations are consistent with those budgets and priorities. Build the technical vision for the team, spanningarchitecture, components, dependencies, and technology selection. Act as a leader on the team, proposing and planning keyinitiatives, owning critical goals, and aligning resources. Deliver results through new business features and technicalimprovements that move the needle for customers with results. Influence,collaborate, and communicate effectively with business leaders Determine the organization's long-term systems and/or hardware needs to accomplish the organization's business objectives. Analyze the needs of departments and establish priorities for feasibility studies, systems design, and implementation to develop new and/or modify the company's...
Jan 20, 2021
Position Purpose: Oversee department staff including hiring, performance management and career development to ensure alignment with defined goals. Develop budgets and priorities, ensuring plans and resource allocations are consistent with those budgets and priorities. Build the technical vision for the team, spanningarchitecture, components, dependencies, and technology selection. Act as a leader on the team, proposing and planning keyinitiatives, owning critical goals, and aligning resources. Deliver results through new business features and technicalimprovements that move the needle for customers with results. Influence,collaborate, and communicate effectively with business leaders Determine the organization's long-term systems and/or hardware needs to accomplish the organization's business objectives. Analyze the needs of departments and establish priorities for feasibility studies, systems design, and implementation to develop new and/or modify the company's...
Position Purpose: Serve as a liaison between the plan, claims, providers and various departments to effectively identify and resolve claims issues Audit check run and send claims to the claims department for corrections Identify any system changes and work notify the Plan CIA Manager to ensure its implementation Collaborate with the claims department to price pended claims correctly Document, track and resolve all plan providers' claims projects Collaborate with various business units to resolve claims issues to ensure prompt and accurate claims adjudication Identify authorization issues and trends and research for potential configuration related work process changes Analyze trends in claims processing issues and assist in identifying and quantifying issues and reviewing work processes Identify potential and documented eligibility issues and notify applicable departments to resolve Research the claims on various reports to determine if appropriate to...
Jan 20, 2021
Position Purpose: Serve as a liaison between the plan, claims, providers and various departments to effectively identify and resolve claims issues Audit check run and send claims to the claims department for corrections Identify any system changes and work notify the Plan CIA Manager to ensure its implementation Collaborate with the claims department to price pended claims correctly Document, track and resolve all plan providers' claims projects Collaborate with various business units to resolve claims issues to ensure prompt and accurate claims adjudication Identify authorization issues and trends and research for potential configuration related work process changes Analyze trends in claims processing issues and assist in identifying and quantifying issues and reviewing work processes Identify potential and documented eligibility issues and notify applicable departments to resolve Research the claims on various reports to determine if appropriate to...
