- CVS Health (Atlanta, GA)
- …role? Join Aetna/CVS Health, a Fortune 4 company, as the Network Management Senior Manager. In this role, you will manage negotiations, conduct high-level reviews ... and developing yourself and others) skills **Required Qualifications** * Commercial, Medicare , and/or Medicaid knowledge * 5+ years related experience, proven and… more
- Baylor Scott & White Health (Atlanta, GA)
- …a timely way. . Responds to inquiries and guidance requests utilizing applicable Medicare and Medicaid rules and regulations. Serves as a compliance resource to BSWH ... departments and entities on compliance matters. KEY SUCCESS FACTORS . Continually demonstrates initiative by learning business processes and applicable auditing techniques. . Ability to exercise good judgment, attention to detail, integrity, dependability, and… more
- Baylor Scott & White Health (Atlanta, GA)
- …are completed in a timely way. . Responds to inquiries utilizing applicable Medicare and Medicaid guidance. Serves as a compliance resource to BSWH departments and ... entities on compliance matters. _Third Party Compliance_ . Assists in assessing and mitigating risks related to third-party relationships, including bribery, corruption, sanctions, and reputational concerns. . Supports the implementation and maintenance of… more
- CVS Health (Atlanta, GA)
- …trend and report on vendor performance data. + Familiarity with Medicare and Medicaid regulations. **Education** + Associates degree or equivalent experience. ... **Anticipated Weekly Hours** 40 **Time Type** Full time **Pay Range** The typical pay range for this role is: $46,988.00 - $122,400.00 This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within… more
- CVS Health (Atlanta, GA)
- …+ Performs accurate analysis and risk assessment for new business group Medicare Advantage opportunities. + Produces timely and accurate customer specific documents ... for RFP responses. + Work closely with the sales team to provide strategic solutions which are affordable and satisfactory to the member and plan sponsor. + Drives for results by working across departments and functions in a focused and collaborative manner. +… more
- CVS Health (Atlanta, GA)
- …with provider engagement, relations, or account management. + Working knowledge of Medicare contracts. + An understanding of value based contracts, how they work, ... what is the value. + Strong presentation skills, the ability to communicate effectively. + Mastery of problem solving and decision making skills + Strong MS Office skills. Preferred Qualifications: + The ability to use data to tell a story. + Mastery of growth… more
- PruittHealth (Macon, GA)
- …and levels of care. 2. Must be knowledgeable of private insurance, Medicare and Medicaid coverage criteria, rules and regulations and reimbursement methodologies. 3. ... Taking responsibility for a regional territory of hospitals and community services in order to facilitate the placement of patients within the Pruitt Health continuum. 4. Duties include taking call for discharge planners in need of assistance, providing on… more
- Molina Healthcare (Columbus, GA)
- …Directory (including ongoing execution, QA and maintenance of supporting tables), Medicare Provider Directory preparation, and FQHC/RHC reports. + Generates other ... provider-related reports, such as: claims report extractions; regularly scheduled reports related to Network Management (ER, Network Access Fee, etc.).; and mailing label extract generation. + Develops and maintains documentation and guidelines for all… more
- CVS Health (Atlanta, GA)
- …years Industry experience in mental or behavioral health, payer, commercial, and Medicare + Proven ability to interact with, influence and collaborate with business ... leaders and producing managers at all levels + PMP certification + Experience with enterprise-wide and/or cross-functional large-scale initiatives with high degree of complexity **Education** + Bachelor's degree or equivalent professional work experience **Pay… more
- Emory Healthcare/Emory University (Atlanta, GA)
- …and Grady Health System. Fellows must be eligible at participants in Medicare , Medicaid and other third-party payers contracted with Emory Healthcare and Grady ... Health System + Other concerns or modifications from the standard curriculum outline will be considered on an individual basis **Key Responsibilities (non-program specific):** + Provide high quality patient care in one or more of the program's affiliated… more