- Robert Half Finance & Accounting (Carlisle, PA)
- …plays a critical role in optimizing billing, coding, claims processing, insurance verification, and collections to ensure compliance and maximize reimbursement. The ... efficiency. Responsibilities: * Oversee the revenue cycle processes for Medicaid, Medicare , managed care, commercial payers, and sliding fee programs. * Establish… more
- US Tech Solutions (Pittsburgh, PA)
- …calls. You will take inbound calls and answer questions regarding prescription insurance , medication coverage and mail order prescriptions so that our members better ... will offer the solutions needed to help simplify their health care experience. You will have the opportunity to...the provider and member regarding their prior authorization/ PBM/ Medicare . + Review and process prior authorization requests by… more
- AmeriHealth Caritas (West Chester, PA)
- …hybrid work schedules, Competitive pay, Paid time off including holidays and volunteer events, Health insurance coverage for you and your dependents on Day 1, ... goals are met + Ensure compliance with all relevant state and federal health payer regulations, payer policies, and contractual agreements and maintain accuracy and… more
- Humana (Harrisburg, PA)
- **Become a part of our caring community and help us put health first** The Humana Integrated Business Advancement (IBA) - BI (Business Intelligence) team is a high ... Intelligence Engineer position will be supporting BI work for our Medicare organizations. **Senior Business Intelligence Engineer** : + Develops and maintains… more
- Humana (Harrisburg, PA)
- **Become a part of our caring community and help us put health first** The Lead, Data Quality/Integrity understands end-to-end master data processes and flows and ... reporting on progress, challenges, and achievements to management. + Partner with Medicare Risk Adjustment (MRA) and vendors to establish data feeds for STARs… more
- Humana (Harrisburg, PA)
- **Become a part of our caring community and help us put health first** The Senior Coding Educator identifies opportunities to improve provider documentation and ... Certified Risk Coder (CRC) + Experience interacting with healthcare providers + Medicare Risk Adjustment knowledge + Analyzing data to build unique education… more
- Humana (Harrisburg, PA)
- **Become a part of our caring community and help us put health first** The Actuarial Analyst 1 provides actuarial support across a broad range of actuarial and ... + SAS and/or Databricks experience + Programming experience in SQL and VBA + Medicare Part D knowledge Travel: While this is a remote position, occasional travel to… more
- Humana (Harrisburg, PA)
- **Become a part of our caring community and help us put health first** The Actuary, Pricing is responsible for setting pricing assumptions, submitting bids, filing ... focused on continuously improving consumer experiences **Preferred Qualifications** + Medicare Advantage experience + Strong Communication Skills + Ability to… more
- Humana (Harrisburg, PA)
- **Become a part of our caring community and help us put health first** Code Edit Disputes team reviews and educates providers when there is a dispute on adjudicated ... Coder + Demonstrate ability to problem-solve complex coding issues + Experience with Medicare and Medicaid coding guidelines + Strong data entry and attention to… more
- Humana (Harrisburg, PA)
- **Become a part of our caring community and help us put health first** This Actuarial Analyst 2 position is a part of the HealthCare Economics team focused on ... 2+ years of actuarial experience in healthcare + SAS or other coding skills + Medicare experience + Familiarity with CMS Star Ratings Travel: While this is a remote… more