- Healthfirst (Enfield, NY)
- …+ Sales Support has the primary responsibility of connecting Healthfirst with community-based organizations, community health centers, NYCHA, community providers, ... faith-based organizations, community boards, and city agencies. + Develop twenty (20) events and/or opportunities per months for the sales representatives which they support. + Establish new relationships and maintain existing ones. + Support the Sales and… more
- Healthfirst (NC)
- …employees know, understand, and can follow them. + Identify the top human risks to Healthfirst and the behaviors we need to change to mitigate that risk. Develop and ... a simple, clear, and concise manner to target various departments cross Healthfirst . + Project management experience to help in planning, managing, and maintaining… more
- Healthfirst (NJ)
- …to ensure comprehensive and defensible claims editing is in place across all Healthfirst product lines + Participate in special projects and advanced Claims Coding ... reports on performance of current claims editing packages to substantiate savings to Healthfirst + Serves as a subject matter expert to defend claims payment policy… more
- Healthfirst (Enfield, NY)
- …strong downline partner relationships that enable growth and improve satisfaction with Healthfirst , + Ensures routine partner needs are met and potential problems ... opportunities. + Supports the improvement of the quality and efficiency of Healthfirst Medicare by delivering high quality account management and sales operations… more
- Healthfirst (FL)
- …Partnership with product manager to develop product vision and delivery roadmap for team; prioritization Create and refine Epics, Features and User stories for team ... to deliver Influences key stakeholders and senior leadership and secures buy in to opportunities reflected on the product roadmap Communicate outcomes, risks and dependencies clearly and on time to support impediment resolution and ensure quality delivery… more
- Healthfirst (FL)
- …+ Leadership experience in a high volume production billing, enrollment, claims, call center environment or related environment. + Background in providing customer ... service or improving the members experience while addressing customer issues and complaints in a timely manner. + Direct supervisory or management experience in an operational department within the healthcare industry (which can include commercial insurance… more
- Healthfirst (NY)
- **Duties and Responsibilities:** + Monitor experience under Healthfirst 's Medicare line of business. + Provide support for annual Medicare bids for all ... Healthfirst 's Medicare products. + Assist in other actuarial functions such as in incurred but not reported (IBNR) analysis and other ad hoc analyses. + Research,… 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. + Generates referrals to providers, community-based resources, and appropriate services and other resources to assist and maintain of successful health outcomes. + Liaise between service providers such as doctors, social… more
- Healthfirst (NY)
- …Applies clinical and critical thinking skills in evaluating the content of disenrollment requests Communicates with the clinical teams regarding safety concerns and ... regulatory requirements on an ongoing basis Proficiently uses systems and applications such as TruCare, PEGA, MHS, ePACES and CMS. Validates content of disenrollment requests in reviewing of Uniform Assessment System (UAS) assessments, care plans, medical… more
- Healthfirst (NY)
- …+ Provides case management services for assigned member caseloads which includes: + Pre-certification performing risk-identification, preadmission, concurrent, and ... retrospective reviews to evaluate the appropriateness and medical necessity of treatments and service utilizations based on clinical documentation, regulatory, and InterQual/MCG criteria + Assessment - identifying medical, psychological, and social issues that… more
- Healthfirst (NY)
- …+ 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 (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… more
- Healthfirst (NY)
- …+ HS Diploma/GED **Preferred Qualifications** + Bachelor's degree + Base SAS certification + Certified Pharmacy Technician + MS Project: Ability to create schedules ... that include interdependencies, predecessors and successors between tasks. Must also be able to create baselines, provide milestone reports as well as manage resources and work hours. + Experience working with a Pharmacy Benefit Manager (PBM) within a health… more
- Healthfirst (NY)
- …+ Partner with Finance Business Partner to support State Programs teams to monitor product financial performance + Collaborate with teams across the organization, ... including within the Finance Department, to connect the dots and understand all the levers to improve product performance + Support business case development for new growth and market opportunities for the State Programs products + Monitor budget versus… more
- Healthfirst (NY)
- …+ Conduct assessments for prospective members and re-assessments of current members as well as identify enrollment and or eligibility by utilizing clinical expertise ... and critical thinking skills. As needed, conducts assessments in settings other than home eg skilled nursing facilities. + Conduct In-person Care Management visits in support of person-centered service planning. + Complete assessments of member needs due to… more
- Healthfirst (NY)
- Coordination of contracts with external and internal producers |Oversight of the entire appointment process to ensure proper completion of contracts and marketing ... agreements for internal agents and commercial brokers/GA |Responsible for review of credentialing paperwork, confirmation of active licenses, and assignment of specific coding to be assigned to all new business for tracking and payment purposes |Assist in… more
- Healthfirst (NY)
- …+ Monitor and review prior authorization requests for medications + Calculate appropriate billable units based on dosing, indication, weight, BMI and other clinical ... considerations + Develop clinical criteria and medical policies for the review of medications + Ensure all clinical criteria is in compliance with Center of Medicare and Medicaid Services (CMS) and the New York State Department of Health (NYSDOH) + Research… more
- Healthfirst (NY)
- …+ Applies care management principles by advocating, informing, and educating beneficiaries on services, self-management techniques, and health benefits related to the ... continuum of care + Reviews discharge planning, assessments, medical records, and screening for members currently admitted to assigned facilities + Assesses need for home care, out of home placement, and/or community-based services and may be called upon to do… more
- Healthfirst (NE)
- …your work experience, education, licenses and certifications, and any other factors Healthfirst deems pertinent to the hiring decision. In addition to your salary, ... Healthfirst offers employees a full range of benefits such...401k contributions (all benefits are subject to eligibility requirements). Healthfirst believes in providing a competitive compensation and benefits… more
- Healthfirst (NY)
- …+ Handle premiums, claims, enrollment, and administrative expense data for reports to government and regulatory entities (such as CMS, NYSID, NYDOH, etc.) as well as ... routine internal reports + Perform risk score, pricing and other data analytics for Medicare products + Assist in the Medicare Part C and Part D bid process, including bid preparation and desk review follow-ups + Monitoring experience and analyzing performance… more
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