- Teva Pharmaceuticals (Parsippany, NJ)
- …states/programs. Communicate to manager for key findings and changes to state programs. + Provide backup for Medicaid team members in any necessary functions and ... Medicaid Claims Analyst Date: Apr 19, 2025 Location:...terms. This position also provides assistance in resolving dispute resolution , weekly pay run activities, SOX audits, system upgrade/implementation… more
- Teva Pharmaceuticals (Parsippany, NJ)
- …states/programs. Communicate to manager for key findings and changes to state programs. + Provide backup for Medicaid team members in any necessary functions and ... Medicaid Claims Analyst Date: Apr 16, 2025 Location:...terms. This position also provides assistance in resolving dispute resolution , weekly pay run activities, SOX audits, system upgrade/implementation… more
- WellSense (Boston, MA)
- … provider types. The Snr PRC acts as liaison between behavioral health provider network and key internal health plan departments and works closely with ... Senior Provider Relations Consultant, BH Network Strategy...effective business interactions and outreach** + **Initiates and facilitates resolution of complex contractual and member/ provider issues… more
- Trinity Health (Columbus, OH)
- …**Responsibilities** + Recruit providers to build a cost effective and high quality provider network within MediGold guidelines. + Serve as the MediGold point ... in MediGold's Ohio market, including: contracting and recruitment, issue resolution and escalations, strategy development and execution, education, and...of contact within the Provider network ; Act as the MediGold Subject… more
- LA Care Health Plan (Los Angeles, CA)
- Provider Network Account Manager III Job Category: Provider Relations Department: Provider Network Management Location: Los Angeles, CA, US, 90017 ... public agency created by the state of California to provide health coverage to low-income Los Angeles County residents....net required to achieve that purpose. Job Summary The Provider Network Account Manager III is responsible… more
- Centene Corporation (Phoenix, AZ)
- …party for resolution + Receive and effectively respond to external provider related issues + Provide education on health plan's innovative contracting ... training, orientation and coaching for performance improvement within the network and assist with claim resolution . +...oversee testing and completion of change requests for the network + Investigate, resolve and communicate provider … more
- AmeriHealth Caritas (Asheville, NC)
- … provider issues. The position also involves monitoring and managing the provider network to ensure appropriate access to services, maintaining financial ... high-spend providers with multiple locations or specialties. + Monitor and manage the provider network to ensure compliance with state and federal mandates, as… more
- Centene Corporation (Olympia, WA)
- …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
- AmeriHealth Caritas (Harrisburg, PA)
- …services. Discover more about us at www.amerihealthcaritas.com . **Position Overview:** The Provider Network Account Executive I (AE I) conducts orientation ... as a proactive practice account leader, and coordinates the resolution of provider issues. Demonstrates a working...and revisions. **Key Responsibilities:** + Monitor and manage the provider network to ensure appropriate access to… more
- Humana (Richmond, VA)
- …Horizons in Virginia Medicaid network . This role supports provider onboarding, training, education, and inquiry/issue support resolution . This role ... ensure positive provider experience with Humana Healthy Horizons and promote network retention + Meet regularly, both in person and virtually, with assigned… more
- Humana (Fairfax, VA)
- …management for network providers in Humana's Healthy Horizons in Virginia Medicaid Plan. This role supports provider onboarding, training, education, and ... positive provider experience with Humana Healthy Horizons and promote network retention + Meet regularly, both in-person and virtually, with assigned providers… more
- CVS Health (Hartford, CT)
- …develop and maintain positive relationships with various clients. **Responsibilities** **Contracting-Health Care Provider - 40%** -- Provide network contract ... heart, each and every day. **Position Summary** In this position, you will support the Provider Network Services legal and business teams with respect to a wide… more
- Molina Healthcare (Madison, WI)
- …must live in Wisconsin _** **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 . Plans, organizes, staffs, and coordinates the Provider … more
- Elevance Health (Columbus, GA)
- …focused on network participation, reimbursement or claims payment inquiries, and/or the resolution of provider data issues. + Travels 25% of time, meets ... Value-Based programs. + Experience with Medicare HEDIS strongly preferred; Commercial and Medicaid a plus. + Experience driving provider performance around cost… more
- BlueCross BlueShield of North Carolina (NC)
- … community enabling BCBSNC to become market leading. 2) Retaining a competitive provider network through innovative approaches to reducing provider ... for ensuring adherence to the negotiated agreement for all provider types for all BCBSNC products. Primarily responsible for:...managing a strategy to schedule, plan and visit specific network providers to: + Present or reiterate the BCBSNC… more
- Molina Healthcare (Joliet, IL)
- …and must live in Illinois _** **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 ...environmental support including, but not limited to: New Markets Provider /Contract Support Services, PCRP & CSST resolution … more
- Molina Healthcare (Milwaukee, WI)
- …Description** **Remote and must reside in Wisconsin** **Job Summary** Molina Health Plan Network Provider Relations jobs are responsible for network ... 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
- Vatica Health (OH)
- …+ Utilize and continuously enhance a national playbook for engaging Vatica Health's provider network , including best practices for engagement and issue ... well as those of its health plan partners + Provide leadership that combines broad, strategic vision with a...dashboards and scorecards + Drive strategic initiatives within the provider network and ensure that the alignment… more
- Molina Healthcare (Manhattan, NY)
- …Manhattan and surrounding area _** **Job Description** **Job Summary** Molina Health Plan Network Provider Relations jobs are responsible for network ... 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
- Centene Corporation (Trenton, NJ)
- …and act as a liaison between the providers and the health plan + Triages provider issues as needed for resolution to internal partners + Receive and effectively ... respond to external provider related issues + Investigate, resolve and communicate ...trainings, orientations, and coaches for performance improvement within the network and assists with claim resolution . **Education/Experience:**… more