- Bryan Health (Lincoln, NE)
- …therapy and consults with attending Physician for referral to appropriate provider . *Maintains awareness of financial reimbursement methodology, utilization ... for the clinical, psychosocial and utilization coordination of the patients hospital experience. Proactively consults with the interdisciplinary team which includes… more
- Humana (Boston, MA)
- …our caring community and help us put health first** The Medicaid (PPS) Provider Hospital Reimbursement Analyst also known as a Senior Business ... the Pricer Business and System Support team responsible for administering complex Medicaid provider reimbursement methodologies. The associate will support… more
- Humana (Nashville, TN)
- …and reimbursement rates to providers in building and maintaining Medicaid Behavioral Health provider networks. Analyzes the financial impact(s) of ... Provider Contracting Professional initiates, negotiates, and executes physician, hospital , and/or other Behavioral Health contracts and agreements within the… more
- AdventHealth (Altamonte Springs, FL)
- …Springs, FL **The role you will contribute:** This position leads AdventHealth's Medicaid reimbursement process across the entire company focusing on ... supplemental Medicaid payments, provider taxes, Medicaid ...team:** + Serves as AdventHealth subject matter resource for Medicaid reimbursement matters. This role is focused… more
- OhioHealth (Columbus, OH)
- …This position will be responsible for ensuring the appropriate governmental (Medicare and Medicaid ) reimbursement is received for OhioHealth. * This position is ... projects as assigned. * Extensive knowledge of Medicare and Medicaid cost reporting and reimbursement and remaining...Hospice. Projects as assigned by Director of Revenue and Reimbursement and Manager of Reimbursement . Provide… more
- Humana (Nashville, TN)
- …part of our caring community and help us put health first** The Sr. Medicare (PPS) Provider Hospital Reimbursement Analyst will be an integral part of the ... of the team as it expands to accommodate the increased responsibilities. The Provider Hospital Reimbursement Analyst r will be primarily responsible… more
- University of Rochester (Canandaigua, NY)
- …and addressing consequential barriers to securing public benefits which may impact hospital reimbursement and timely discharge. + Possesses a nuanced ... Subtype: Regular Time Type: Full time Scheduled Weekly Hours: 40 Department: 500169 Medicaid Enrollment Work Shift: UR - Day (United States of America) Range: UR… more
- Sacramento Behavioral Healthcare Hospital (Santa Rosa, CA)
- ABOUT US: Formerly Aurora Santa Rosa Hospital , SRBHH was opened in 2016 and is regarded as an integral part of the greater Santa Rosa and Northern California mental ... of care. Conveniently located in the North Bay, this hospital consists of 144 acute psychiatric inpatient beds. Santa...codes, patient diagnosis and authorized level of care. + Provide timely and clear communication of patient eligibility for… more
- Commonwealth Care Alliance (Boston, MA)
- …compliance requirements. + Maintain a solid understanding of Medicare and Medicaid reimbursement methodologies for assigned services. + Conduct on-going ... and health care financing required. + Solid understanding of Medicare and Medicaid reimbursement methodologies and particular expertise in Medicare and … more
- Omaha Children's Hospital (Omaha, NE)
- …methodologies + Conducts research on Federal and State regulations/laws + Coordinates regulatory reimbursement audits of the hospital and represents the System * ... and education. As the state's only full-service pediatric healthcare center, we provide comprehensive, holistic care to our patients and families-from primary and… more
- AmeriHealth Caritas (Washington, DC)
- …dual eligibility health insurance, ACA Exchange Business & DSNPs. + 5 years provider contracting/ reimbursement experience in healthcare setting. + 3 years of ... Responsible for assisting the Leader with departmental activities related to provider satisfaction, education, and communication. This position is also responsible… more
- Humana (Indianapolis, IN)
- …and provides administrative support for BH practitioner, hospital , and/or other provider contracts for Indiana Medicaid and Medicare. The Provider ... Provider Contracting Coordinator communicates contract terms, payment structures, and reimbursement rates to providers in the Indiana Medicaid and Medicare… more
- Molina Healthcare (Grand Island, NE)
- …* Working experience with, and strong knowledge of, various managed healthcare provider compensation and VBP methodologies, primarily across Medicaid and ... live in Georgia _** **Job Description** **Job Summary** Molina Health Plan Provider Network Contracting jobs are responsible for the network strategy and development… more
- Commonwealth Care Alliance (Boston, MA)
- …teams to monitor network performance against internal and regulatory benchmarks. * Ensure provider network compliance with CMS, state Medicaid agency, and NCQA ... 011230 CA- Provider Engagement & Performance Position Summary: The Director...contracting, or population health initiatives. * Prior work with hospital systems, large medical groups, and specialty care networks.… more
- Molina Healthcare (Sterling Heights, MI)
- …* Clearly and professionally communicates contract terms, payment structures, and reimbursement rates to physician, hospital and ancillary providers. * ... contract negotiations in a managed healthcare setting ideally in negotiating different provider contract types, ie physician, group and hospital contracting,… more
- Elevance Health (AR)
- …necessary. **Preferred Skills, Capabilities and Experiences:** + Medicare network contracting/ reimbursement methodology strongly preferred. + Medicaid and ... Provider Network Management Director (Medicare Network Build) JR167138...health systems and affiliated physician groups including employed and hospital -based and hospital owned ancillary providers. Primary… more
- Elevance Health (Los Angeles, CA)
- ** Provider Network Management Director** **Location:** This role requires associates to be in-office 3 days per week, fostering collaboration and connectivity, while ... for employment, unless an accommodation is granted as required by law. The ** Provider Network Management Director** is responsible for developing and managing the … more
- AmeriHealth Caritas (Newark, DE)
- …**Roles and Responsibilities:** + Lead strategic planning, development, and management of the hospital and physician provider network to meet member needs and ... for our communities. They will develop and manage all hospital , physician, and extender networks. This position is also...minimum of 3 years of experience in managed care provider contracting and reimbursement is required, including… more
- Commonwealth Care Alliance (Boston, MA)
- …and strengthening relationships with the Commonwealth Care Alliance's (CCA) diverse provider community - including physician, hospital , behavioral health, ... Mentoring subject matter expert of the team + Managed Care experience (preferably Medicare/ Medicaid ) + Experience in health plan provider relations + Experience… more
- Centene Corporation (Queens, NY)
- …the need for additional health plan providers + Manage and coordinate customized provider contracts and hospital contracts + Participate in physician and ... experience. Experience with state and federal health programs such as Medicaid and Medicare. Provider relations/contracting experience including solid… more
