- The Cigna Group (Erie, PA)
- **WORK LOCATION: Pittsburgh, PA - Western PA/West Virginia market** The **Manager, Provider Contracting Network Management** serves as an integral member of the ... Provider Contracting Team and reports to the AVP, ...matrix partners for network implementation and maintenance. + May provide guidance or expertise to less experienced specialists. **POSITION… more
- Guthrie (Sayre, PA)
- …Degree in related field is preferred. Essential Functions Leadership and Mentorship: Provide guidance and mentorship to Provider Onboarding Coordinators. Act as ... Summary The Senior Provider Onboarding Specialist oversees the onboarding process for...Conduct regular audits to ensure compliance with regulatory standards. Provide detailed reports to leadership. Collaborates with credentialing, enrollment,… more
- Centene Corporation (Harrisburg, PA)
- …Purpose:** Maintain partnerships between the health plan and the contracted provider networks serving our communities. Build client relations to ensure delivery ... act as a liaison between the providers and the health plan + Triages provider issues as needed for resolution to internal partners + Receive and effectively respond… more
- CVS Health (Harrisburg, PA)
- …medical cost management and overall claim/customer service strategies. This role will provide concierge level of service to GLOBAL VIP CLIENT members via timely ... Ensure setup / maintenance of claim file, eligibility file, provider data file and changes. + Lead operational vendor...management team with network and TPA questions or inquiries. Provide support to peers and colleagues working on GLOBAL… more
- Penn Medicine (Bala Cynwyd, PA)
- …Departmental Needs - Full Time - Monday - Friday Hybrid Summary: + The Provider Services Coordinator will provide support of all credentialing / re-credentialing ... for a timely and optimal start into the organization. + Additionally, the Provider Services Coordinator will provide administrative support to the physician… more
- Highmark Health (Harrisburg, PA)
- …providers with various payers for professional services reimbursement. Reviews provider credentialing and/or recredentialing data for accuracy based on licensing ... used in the enrollment processes. **ESSENTIAL RESPONSIBILITIES:** + Completes provider payer enrollment/credentialing and recredentialing with all identified payers… more
- AmeriHealth Caritas (Harrisburg, PA)
- **Role Overview:** The Provider Network Contract Representative oversees the daily operations related to Out of Network (OON) agreements, provider contracts, and ... applications. This role ensures the timely and accurate processing of provider agreements and supplemental packets, maintains detailed records, and supports… more
- Highmark Health (Pittsburgh, PA)
- …for the execution of the strategic plan of the Financial Investigations & Provider Review (FIPR) organization. The strategic plan focuses on the detection and ... and abuse (FWA) and recoupment of related overpayments associated with the company's provider spending. The incumbent will function as a champion and driving force… more
- Evolent (Harrisburg, PA)
- …SOUTHWEST REGION We are seeking a strategic and collaborative Associate Director, Provider Engagement to lead our oncology-focused provider engagement and ... practice transformation efforts in the **New Mexico** . Reporting to the National Provider Engagement Sr. Director, you will be responsible for building and managing… more
- Highmark Health (Harrisburg, PA)
- … demographics. Oversees an internal audit quality review program designed to ensure provider data accuracy and completeness, and to provide staff with feedback ... office once monthly.** This job manages a team of provider file representatives who are responsible for the system...experience performing Medicaid and /or Medicare systems setup of provider contracts and provider demographics + 3… more