- Cardinal Health (Boston, MA)
- …when there are specific managed care operations questions including contract questions and analysis related to reimbursement . + Support sales including ... lines of business including Medicare, Medicaid, and various commercial markets. The Managed Care Market Manager is responsible for maintaining the relationship… more
- Highmark Health (Boston, MA)
- …Healthcare, Healthcare Insurance, Consulting or related area + 3 years Value-based reimbursement , through managed care contracting, provider reimbursement ... This job supports the matrixed strategic design and analytical approach to reimbursement . To be successful, the incumbent will work closely with stakeholders across… more
- Beth Israel Lahey Health (Wakefield, MA)
- …market comparative models Ensure accuracy of the rates and fee schedules and related contract language of managed care agreements against negotiated terms. ... of payor contract performance and projected trends. Manage presentation of managed care contracted rate summaries and fee schedules and ensure updated… more
- Beth Israel Lahey Health (Cambridge, MA)
- … and governmental contracts (MassHealth and MSSP). Work with Managed Care contracting team to negotiate equitable reimbursement and value-based terms. ... health outcomes. **Job Description:** **BILHPN President Population Health & Managed Care ** is responsible for developing and...and engaging health plans accordingly. + Coordination with the Contract & Finance Committee of the board and the… more
- Baylor Scott & White Health (Boston, MA)
- …correspondence to collect inaccurate insurance payments and penalties according to BSWH Managed Care contracts. Maintains collection files on the accounts ... to resolve payment difficulties and penalties owed to BSWH in accordance with Managed Care contracts. Contacts insurance company representatives by telephone or… more
- Molina Healthcare (MA)
- …administration experience. * Specific experience in provider services, operations, and/or contract negotiations in a Medicare and Medicaid managed healthcare ... sufficient network of Participating Providers to serve the health care needs of the Plan's patients or members. *...complaints (eg, problems with claims and encounter data, eligibility, reimbursement , and provider website). * Serves as a resource… more
- Point32Health (Canton, MA)
- …industry **Experience** + Required (minimum): A minimum of 5-7 years' experience Managed Care , preferably at a Health Plan, in a ... Point32Health builds on the legacy of Harvard Pilgrim Health Care and Tufts Health Plan to provide access to.... **Job Summary** The Provider Vendor Manager supports sourcing, contract execution, and performance management for key vendor partners,… more
- Humana (Boston, MA)
- …**Required Qualifications** + 2 or more years of experience in negotiating managed care contracts with physician specialty, hospital and/or other provider ... provides health insurance. Provider Contracting Professional 2 + Actively communicates contract terms, payment structures, reimbursement rates to providers… more
- Datavant (Boston, MA)
- …specialist will be responsible for reviewing and validating DRGs specific to Medicare and Medicare Managed Care . Interest in coding IP charts in the event the ... contract ends. Must be able to work 40 hours/week...reviewing and validating DRGs specific to Medicare and Medicare Managed Care . Interest in coding IP charts… more
- Northeast Family Services (Dorchester, MA)
- …referral sources. + Expand and strengthen relationships with state agencies, payers, managed care organizations, and other key stakeholders. + Evaluate ... behavioral health organization dedicated to delivering high-quality, accessible mental health care to children, adults, and families. With programs across multiple… more