- Healthfirst (NY)
- …+ Work as a senior member of the cloud engineering team + Develop automated capabilities to deliver capabilities more efficiently + Drive solutions to problems ... impacting mission critical systems and implement automation to prevent reoccurrence + Execute changes on production systems + Work in center of excellence for cloud usage and cloud development standards + Work closely with other development and operations team… more
- Healthfirst (FL)
- …etc.) + Ensures quality of technical solutions as data moves across Healthfirst environments + Provides insight into the changing data environment, data processing, ... works with data consumers on updates + Aligns data architecture to Healthfirst solution architecture; contributes to overall solution architecture + Helps maintain… more
- Healthfirst (FL)
- …+ Manage the relationship and resolution of Member inquiries with respect to all Healthfirst vendor partners in concert with or on behalf of the Member(s) + Meet ... medical and departmental information; adhere to local, state, federal and Healthfirst specific compliance and regulatory guidelines + Build sustainable relationships… more
- Healthfirst (NY)
- …+ Contributes to the strategic development of the CE engagements calendar + Responsible for end-to-end event planning and implementation + Tracks Budgets and Vendor ... Management for Events and Conferences + Manage project plans for long term and short-term Initiatives + Directs the event reporting arm of the department: development, track, and report key operational indicators; identify partner and/or service gaps and other… more
- Healthfirst (NY)
- …to business decision logs, data universes, etc. + Partners with key Healthfirst stakeholders such as but not limited to Legal, Regulatory, Compliance, Finance, ... and Pharmacy to identify, understand, and process audit deliverables + Responds to regulatory actions and audit inquiries timely and effectively + Identifies and recommends process improvements to better ensure compliance with regulations + Additional duties… more
- Healthfirst (NY)
- …+ HS Diploma or GED **Preferred Qualifications:** + Bachelors degree + Knowledge of related NY state and federal regulations highly desirable + Proficiency in ... + Prepare cases for the clinical team by gathering documentation, loading evidence, and making calls to members and providers. + Perform administrative activities including but not limited to generating and printing determination and authorization notification… more
- Healthfirst (FL)
- …Aligns Testing Support Services under the Quality Assurance Team for strategic planning as it pertains to organization standards. Builds the testing process and ... policies along with defining technical solutions and tools to support the testing framework. Ensures that standardized QA methods and procedures are used for efficient and prompt handling of all testing activities and automation opportunities. Emphasizes cross… more
- Healthfirst (FL)
- …Advocates, informs, and educates beneficiaries on services, self-management techniques, and health benefits. Conducts assessments to identify barriers and ... opportunities for intervention. Develops care plans that align with the physicians treatment plans and recommends interventions that align with proposed goals. Generates referrals to providers, community-based resources, and appropriate services and other… more
- Healthfirst (FL)
- …Advocates, informs, and educates beneficiaries on services, self-management techniques, and health benefits. Conducts assessments to identify barriers and ... opportunities for intervention. Develops care plans that align with the physicians treatment plans and recommends interventions that align with proposed goals. Generates referrals to providers, community-based resources, and appropriate services and other… more
- Healthfirst (NY)
- **Duties & Responsibilities:** + Works collaboratively to design and manage the Healthfirst Pharmacy Benefits for all Healthfirst plans. + Collaborates with ... and Actuary to analyze, interpret, and manage pharmacy cost trends for all Healthfirst plans + Provides support and/or oversight for all clinical and operational… more
- Healthfirst (NY)
- …+ Responsible for case development and resolution of clinical cases, such as: Pre-existing Conditions, Prior Approval, Medical Necessity, Pre-certification, Continued ... Stay, Reduction, Termination, and Suspension of services. The end to end process requires the Specialist to independently: + Research issues + Reference and understand HFs internal health plans policies and procedures to frame decisions + Interpret regulations… more
- Healthfirst (NC)
- …roles, people leader roles, business analytics, workforce effectiveness and other areas. Healthfirst is committed to the well-being of its employees, offering an ... & Accident Insurance, Flexible Reimbursement Accounts, Employee Assistance Plan, Healthfirst 401(k) plan, and much more. Should you join...Agent Class. Thank you for considering a career with Healthfirst . We look forward to the possibility of you… more
- Healthfirst (NY)
- …with team members and other stakeholders. Effectively communicate program expectations to Healthfirst and vendor stakeholders in a timely and clear fashion. + Act ... managing regular QA processes related to communications sent on Healthfirst 's behalf to member and providers, as well as...as facilitating scheduled or ad hoc audits done by Healthfirst or other external experts. Develop and maintain … more
- Healthfirst (NY)
- …+ Understand claim payments and impact of fee-schedule updates from State/CMS. + Assist and monitor direct payment initiatives from the state for Provider ... Organizations + Responsible for contract analysis and fee schedule modeling. + Maintain current project logs and work plans on assignments. + Create and maintain database for fee schedules changes. + Collaborate and Coordinate with teams in Finance for all the… more
- Healthfirst (NY)
- …+ Utilize established workflows and procedures for multistate payroll operations. Ensure compliance and accuracy of payroll tax processing + Reconciliation and ... analysis of tax data + Preparation of tax funding where required + Identification and/or resolution of payroll issues as they arise + Verify system tax calculations, and update tax rates in Workday as required + Research and resolve assigned payroll tax… more
- Healthfirst (NY)
- …improvement, prioritizing projects, and building critical relationships with other Healthfirst departments + Builds sustainable relationships of trust through open ... and interactive communication with internal and external customers + Additional duties as assigned **Minimum Qualifications:** + HS diploma or GED + Working experience in a fast-paced environment + Proficient in Microsoft Office Suite applications including… more
- Healthfirst (NY)
- …teams to relink cases that have active coverage but are not linked to Healthfirst plans in the system by providing proof of services. Assist the Disenrollment team ... in reviewing all membership that has inactive Medicaid coverage by assisgning case to be worked on by the Entitlement Advocate team and following up on them weekly until they are Eligible/active. Has full and complete access to patient records and reports as… more
- Healthfirst (Enfield, NY)
- …home visits per day (clustered in small geographic areas) Supports the Healthfirst clinical team members, including UAS nurses and Care Managers, by facilitating ... needed, escalates member questions, as directed Properly documents findings in Healthfirst information systems Collaborates with other members of the clinical team… more
- Healthfirst (NY)
- …Scope, plan, and oversee project tasks, timelines, deliverables, and the internal and external people engaged in multiple projects Works in deep partnership and daily ... collaboration with the OD program or project lead ensuring an agreed upon, timely, flawless delivery Coordination of a variety of tasks which make enterprise-wide employee development programs run flawlessly, such as building and managing rosters, scheduling… more
- Healthfirst (PA)
- …+ Maintains tracking tools to log audit results including areas of non-compliance and informing what areas of improvement are needed for discussion with management ... and/or at departmental team meetings + Assists with evaluating and analyzing aggregate quality performance data + Develops strategies for business performance improvement initiatives. This includes: identifying opportunities for improvement, problem… more
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