- WellSpan Health (York, PA)
- …efficient and accurate resolution of all Hospital and Professional Billing insurance credits in accordance with established policies and procedures. Researches payor ... various functions within the credit balance AR including but not limited to insurance refund and adjustment requests. + Investigates historical data for each account… more
- Penn Medicine (Lancaster, PA)
- …good standing with Medicare , Medicaid, and other federal and state health insurance programs, ie not excluded from participation in Medicare , Medicaid or any ... Medicare , Medicaid, and other federal and state health insurance programs, ie not excluded from participation in ...insurance programs, ie not excluded from participation in Medicare , Medicaid or any other federal or state health… more
- UPMC (Hanover, PA)
- …maintain privileges at all satellite hospitals and maintain provider privileges (including Medicare UPIN #'s) for all accepted insurance products. **Licensure, ... Certifications, and Clearances:** Audiology State License in the practicing state. + Licensed Clinical Audiologist + Act 31 Child Abuse Reporting with renewal + Act 33 with renewal + Act 34 with renewal + Act 73 FBI Clearance with renewal **UPMC is an Equal… more
- Humana (Harrisburg, PA)
- …and researching laws and regulations applicable to actuarial science and insurance operations. Advises executives to develop functional strategies (often segment ... submission of bids to support Humana's pricing and product development of Medicare Advantage and Prescription Drug Plans that positively impact the financial… more
- Humana (Harrisburg, PA)
- …ensuring the accurate and timely submission of encounter data to Medicaid, Medicare , and DSNP states, while maintaining adherence to all regulatory requirements. The ... is responsible for ensuring the integrity and accuracy of Medicaid and Medicare encounter data across multiple trading partners. This role collaborates with Product… more
- Humana (Harrisburg, PA)
- …You'll play a key role in shaping financial insights, supporting Medicare -related initiatives, and guiding analytical projects that impact business outcomes. + ... Lead financial analytics projects, with a focus on outcomes of Medicare risk adjustment operations and initiatives. + Work independently to analyze historical and… more
- Humana (Harrisburg, PA)
- …+ 3+ years of SQL experience, preferably in SSMS. **Preferred Qualifications** + Medicare Advantage experience. + Experience with SQL and VBA highly preferred. + ... Information** + This role is part of a team that owns the Medicare Advantage pricing methodology and supporting tools in the ecosystem. Travel: While this… more
- Humana (Harrisburg, PA)
- …approvals, as well as modeling financial impact of emerging therapeutics across Medicare and Medicaid LOBs + Researches and analyzes drugs and emerging therapeutics, ... experiences **Preferred Qualifications** + PharmD + Health Plan experience + Knowledge of Medicare as it relates to pharmacy + Six Sigma and/or Project Management… more
- Humana (Harrisburg, PA)
- …This role will support a few tools used within our Individual Medicare Advantage pricing and internal reporting process. This includes: + Helping make ... Qualifications** + Strong technical skills, especially SQL and VBA + Individual Medicare Advantage experience Travel: While this is a remote position, occasional… more
- Humana (Harrisburg, PA)
- …expert on the End Stage Renal Disease (ESRD) population for Humana's individual Medicare Advantage plans. This includes: + Owning and improving our ESRD claims ... technical skills, especially SQL, VBA, and Databricks/Python + Individual Medicare Advantage experience + Knowledgeable on ESRD population **Additional Information**… more