- Humana (Raleigh, NC)
- …+ Work closely with enterprise teams on claims processing, reporting, contracting/credentialing, network adequacy, provider dispute resolution issues, and ... CANDIDATE MUST RESIDE IN NORTH CAROLINA. The North Carolina Medicaid Provider Services Director leads a team... services model and executes strategic initiatives within the provider network . + Conduct regular performance evaluation… more
- AmeriHealth Caritas (Detroit, MI)
- …than just numbers-it's the foundation of trust, access, and quality care. As a Senior Provider Network Data Analyst, you'll be at the center of that mission, a ... departments, and play a key role in shaping a provider network that delivers on our promise...level goals and lead meetings when needed. + Support provider recruitment, contract management, credentialing, and complaint resolution… more
- AmeriHealth Caritas (Fayetteville, NC)
- …services. Discover more about us at www.amerihealthcaritas.com **Role Overview:** The Provider Network Account Executive (AE II) is responsible for ... provider issues. The position also involves monitoring and managing the provider network to ensure appropriate access to services, maintaining financial… more
- Centene Corporation (Nashville, TN)
- …and directories as well as claims payment resolution as it relates to provider set up. + Provide support to the external provider representative ... group, ancillary, etc.) are set up accurately in the provider information system for state reporting, claims payment, and...state deliverables, network reporting… more
- Molina Healthcare (Houston, TX)
- …and must live in Texas _** **Job Description** **Job Summary** Molina Health Plan Network Provider Relations jobs are responsible for network development, ... staff are the primary point of contact between Molina Healthcare and contracted provider network . In partnership with Director, manages and coordinates the … more
- Humana (Springfield, IL)
- …plan. + Work with internal corporate partners to ensure cross-department communication and resolution of provider 's issues. + Work with internal resources and ... systems (eg, claims, reimbursement, provider enrollment) to provide the Perfect Experience...Ensure compliance with Illinois's managed care contractual requirements for provider relations, such as claims dispute resolution … more
- Magellan Health Services (Albuquerque, NM)
- …Medicaid , Medicare, and Commercial lines of business. This role includes managing provider contracting activities in coordination with the Network team and ... requirements. Strong collaboration with internal departments is essential to maintain network accuracy, provider data integrity, and overall operational… more
- CVS Health (Oxford, OH)
- …**Preferred Qualifications:** + Knowledge of Medicaid Regulatory Standards for Network Access, Credentialing, Claims Processing, Provider Appeals & Disputes ... support business objectives and to identify trends and enlist assistance in problem resolution . + Assist with standard provider recruitment, contracting, or re-… more
- CVS Health (Richmond, VA)
- …**Preferred Qualifications** + Knowledge of Medicaid Regulatory Standards for Network Access, Credentialing, Claim Lifecycle, Provider Appeals & Disputes, ... the business and system requirements of internal customers as it pertains to other provider network management areas. + Oversees receipt of and coordinates … more
- CVS Health (Baton Rouge, LA)
- …with assigned providers and internal business partners to manage relationships and ensure provider needs are met. Ensures resolution of escalated issues related, ... will negotiate and execute high-level review and analysis, manage dispute resolution and settlement negotiations of contracts with single and group Behavioral… more
- Molina Healthcare (Los Angeles, CA)
- …must live in California _** **Job Description** **Job Summary** Molina Health Plan Network Provider Relations jobs are responsible for network development, ... primary point of contact between Molina Healthcare and contracted provider network . They are responsible for ...level of customer service. Effectiveness in driving timely issue resolution , EMR connectivity, Provider Portal Adoption. *… more
- Molina Healthcare (Buffalo, NY)
- …must live in New York _** **Job Description** **Job Summary** Molina Health Plan Network Provider Relations jobs are responsible for network development, ... primary point of contact between Molina Healthcare and contracted provider network . They are responsible for ...level of customer service. Effectiveness in driving timely issue resolution , EMR connectivity, Provider Portal Adoption. *… more
- OhioHealth (Columbus, OH)
- …be a major contributor for the development and managements of the provider network through contract negotiations, relationship development and maintenance. ... Provider Agreement negotiation, and amendment writing 15% Provider issue, problem, &/or concern investigation and resolution...meet or exceed health plan goals and objectives, regarding provider costs and provider network … more
- Elevance Health (Las Vegas, NV)
- …regarding provider issues impacting provider satisfaction and network retention; researches, analyzes, and coordinates prompt resolution to complex ... visits, communicating administrative and programmatic changes, and facilitating education and the resolution of provider issues. + Serves as a knowledge and… more
- Humana (Tallahassee, FL)
- …ensuring that best-in-class servicing is delivered, including onboarding, training, issue resolution , etc. + Identify provider operational performance issues and ... awarded 5-Star ratings by the Centers for Medicare and Medicaid Services in each of the past two years,...talented healthcare/health insurance leader for the role of Director, Provider Contracting. The Director will be responsible for all… more
- Molina Healthcare (Dayton, OH)
- …Plans, organizes, staffs, and leads all activities of the State Plan's Provider Network Management and Operations Department. Works with staff and ... the Plan. Also oversees provider credentialing, delegation oversight and provider network administration activities. Primary plan liaison for Claims, Member… more
- Fallon Health (Worcester, MA)
- …of Providers** + Plan, organize and conduct educational training seminars for assigned provider network to include newly contracted and ongoing education + ... improving health and inspiring hope, we strive to be the leading provider of government-sponsored health insurance programs-including Medicare, Medicaid , and… more
- CVS Health (Sacramento, CA)
- …contracting, provider issues/resolutions, related systems and information contained + Provide guidance and share expertise to others on the team + Understanding ... who negotiates, executes, conducts deep-dive review and analysis of dispute resolution and/or settlement negotiations of contracts with larger and more complex,… more
- CVS Health (Richmond, VA)
- …Promote collaboration with internal partners. * Evaluate, formulate, and implement the provider network strategic plan to achieve contracting targets and manage ... your next role? Join Aetna/CVS Health, a Fortune 4 company, as the Network Management Senior Manager. In this role, you will manage negotiations, conduct high-level… more
- CareOregon (Portland, OR)
- …in the areas of policy management, deliverable management, project coordination, provider network management, dashboard maintenance, and compliance. Essential ... Collaborate with Information Systems (IS) partners to maintain and evolve the Provider Network Insights dashboard. + Proposes and implements process… more