- Humana (Harrisburg, PA)
- …application, and service delivery to ensure high availability, scalability, and compliance with SLAs and regulatory requirements. + Collaborate with business ... + Experience with RPA platforms (eg, UiPath, Automation Anywhere). + Familiarity with compliance standards such as GDPR, HIPAA, SOC 2, and ISO 27001. + Background… more
- Humana (Harrisburg, PA)
- …of matters related to PBM and pharmacy services, including regulatory compliance ; contract drafting, negotiation, and management; and risk management. This position ... benefit plans. + Provide legal guidance on federal and state regulatory compliance . + Advise on risk exposure, mitigation strategies, and legal implications of… more
- Cardinal Health (Harrisburg, PA)
- …initiatives to optimize cash flow, reduce aging accounts, and ensure compliance with payer and regulatory requirements. **Responsibilities:** + Lead and manage ... for complex or high-dollar claims. + Stay current with payer policy changes, compliance regulations, and industry best practices. + Analyze trends in denials and… more
- Geisinger (Danville, PA)
- …accurate patient information relating to registration and insurance in compliance with HIPAA guidelines. Facilitates positive multi-channel communications among ... with patients, referring physicians, departments, specialties and assigned sites in compliance with customer service standards. + Understand and comply with all… more
- ChenMed (Philadelphia, PA)
- …mission-driven, primary care organization, is currently one of the most successful full-risk Medicare Advantage providers in the nation and has a vision to be ... work closely with the applicable managers and medical directors to ensure compliance with guidelines along with participating in risk and quality management… more
- ChenMed (Philadelphia, PA)
- …mission-driven, primary care organization, is currently one of the most successful full-risk Medicare Advantage providers in the nation and has a vision to be ... work closely with the applicable managers and medical directors to ensure compliance with guidelines along with participating in risk and quality management… more
- AmeriHealth Caritas (Harrisburg, PA)
- …such as Credentialing, Clinical, Member Services, and Provider Maintenance, ensuring compliance with state regulations and internal standards. A strong understanding ... of Medicaid, Medicare , and state-funded programs is essential, along with the...providers in completing supplemental packets and OON documentation in compliance with state regulations. + Monitor and manage EXP… more
- Humana (Harrisburg, PA)
- …pillars, including continuous integration (CI), continuous delivery (CD), quality, security, compliance , metrics, and reporting. + Ensure compliance with ... to a better quality of life for people with Medicare , Medicaid, families, individuals, military service personnel, and communities...the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and… more
- WellSpan Health (Gettysburg, PA)
- …sheets, progress notes, and/or electronic medical record for documentation. Validates compliance with system and unit-specific clinical initiatives, ie pain scores, ... duties as identified. + WellSpan Health has adopted and implemented a compliance program to support WellSpan's values and standards for professionalism, integrity,… more
- The Cigna Group (Harrisburg, PA)
- …questions about Pharmacy Benefit Services(PBS) benefits, mail-order pharmacies, or Medicare . + Take calls back-to-back while toggling through several applications ... to maintain the quality of the home delivery process, document HIPAA compliance and reduce potential legal concerns + Resolve questions and/or issues that… more