- CareOregon (Portland, OR)
- …Job Summary This position is responsible for providing system configuration for the organization's managed care payment system ... Nevada, Texas, Montana, or Wisconsin. Job Title IS System Configuration Analyst II Exemption Status Exempt Department Operations Manager...relating to the medical health insurance industry and the Medicare and Medicaid industry. + Consult with… more
- CDPHP (Albany, NY)
- …rules, regulations, enrollment/eligibility guideline and reporting requirements for HMO, PPO, ASO, Medicare , Medicaid , Family Health Plus and Child Health Plus ... to be a part of that experience. The Manager, Configuration will have the responsibility for the oversight, development...compensation, CDPHP employees may be eligible for an incentive payment , a discretionary cash reward based on employee and… more
- LA Care Health Plan (Los Angeles, CA)
- …or in Payment Integrity. At least 5 years participating in healthcare ( Medicare , Medicaid , Commercial). At least 5 years of experience with health care ... Payment Integrity Analyst III (ALD) Job Category: Claims...implementation. Skills Required: Knowledge in CPT, HCPCS, ICD-9, ICD-10, Medicare , and Medicaid rules and regulations. Working… more
- Humana (Columbus, OH)
- …efforts are leading to a better quality of life for people with Medicare , Medicaid , families, individuals, military service personnel, and communities at large. ... health first** Do you have experience in IT Security Configuration Management? If so, you might be a good...home in the state of California will be provided payment for their internet expense. + A minimum standard… more
- WellSense (Boston, MA)
- …health insurance company serving members across Massachusetts and New Hampshire through Medicare , Individual and Family, and Medicaid plans. Founded 25 years ... in a managed care or healthcare environment is preferred + Experience with Medicare and Medicaid reimbursement methodologies + Understanding of provider coding… more
- Humana (Columbus, OH)
- …efforts are leading to a better quality of life for people with Medicare , Medicaid , families, individuals, military service personnel, and communities at large. ... put health first** The Compensation Technology is responsible for the review, configuration , and testing of new internal sales commission plan requirements into our… more
- HealthEdge Software Inc (Columbus, OH)
- …and enterprise level. Our Reimbursement Transformation features Medicare and Medicaid content coupled with flexible contract configuration capabilities for ... Source_ ,we'rechanging the industry narrative, providing a moreholistic approachto payment integrity that focuses on comprehensive reimbursement, agile editing, and… more
- CVS Health (Columbus, OH)
- …Director, Network Management supporting our Ohio and Kentucky markets for our Commercial, Medicare , IFP, and Medicaid businesses. In this role, you will provide ... managing bias. Preferred Qualifications + Demonstrated experience with contracting for Commercial, Medicare , IFP and Medicaid lines of business. + Advanced… more
- CVS Health (New York, NY)
- …improving quality, access, and client satisfaction for Aetna Commercial, Medicaid and Medicare membershipResponsibilities: + Development and accountability ... analytics, including provider risk + Demonstrated experience with contracting for Commercial, Medicare and Medicaid lines of business. + Demonstrated success in… more
- HealthEdge Software Inc (Columbus, OH)
- …and enterprise level. Our Reimbursement Transformation features Medicare and Medicaid content coupled with flexible contract configuration capabilities for ... Source_ ,we'rechanging the industry narrative, providing a moreholistic approachto payment integrity that focuses on comprehensive reimbursement, agile editing, and… more
- Corewell Health (Grand Rapids, MI)
- …information in accordance with the provider's negotiated contract to determine correct configuration of the claims payment system(s). Knowledge of facility and ... years of relevant experience Knowledge of provider reimbursement methods and concepts ( Medicare , Medicaid , Commercial) and industry standard pricing guidelines +… more
- Apex Health Solutions (Houston, TX)
- …UB04 and HCFA 1500 claim content for varying business lines including Medicare Advantage, Commercial Fully Insured, Medicaid , etc. Experience with Microsoft ... collection and analysis regarding provider inquiries and/or disputes or other trending payment integrity activities Acts as point of contact for submission and/or… more
- Humana (Columbus, OH)
- …efforts are leading to a better quality of life for people with Medicare , Medicaid , families, individuals, military service personnel, and communities at large. ... and connectivity for Multi-Cloud environment. + Overseeing and performing administration, configuration , and monitoring of all network equipment & cloud resources… more
- Healthfirst (NY)
- …network of Ancillary Providers for all lines of Healthfirst's business (such as Medicaid , CHP, Medicare , and Commercial). + Monitor and audit contracted ... ancillary providers to ensure that accurate demographic, payment and fee schedules are loaded into the HF...loaded into the HF Provider System correctly + Resolve configuration issues by identifying root causes to prevent claims… more
- University of Utah Health (Murray, UT)
- …editing and proofreading skills. + Detail oriented. + Knowledge of and experience with Medicaid and Medicare insurance programs. + Knowledge of the Utah health ... area. + Previous management experience. + Working knowledge of provider contract configuration related to accurate claims payment that reflects the provider… more
- Humana (Columbus, OH)
- …efforts are leading to a better quality of life for people with Medicare , Medicaid , families, individuals, military service personnel, and communities at large. ... in Talent Acquisition teams + Experience with Workday design, and/or configuration within the Recruiting module **Work-At-Home Requirements:** To ensure Home or… more
- Humana (Frankfort, KY)
- …efforts are leading to a better quality of life for people with Medicare , Medicaid , families, individuals, military service personnel, and communities at large. ... omni-channel personalization efforts, including but not limited to Adobe platform configuration and "next valuable" discussions + Through partnership with customer… more
- Fallon Health (Worcester, MA)
- …strive to be the leading provider of government-sponsored health insurance programs-including Medicare , Medicaid , and PACE (Program of All-Inclusive Care for the ... conflicts to Manager, Provider Data or Sr. Director, Benefit and Provider Configuration as appropriate. + Maintains assignments related to assigned territory, [i.e.,… more