- CVS Health (Austin, TX)
- …medical cost initiatives. Required Qualifications: + 3+ years of provider contracting and relationship experience, including contract language, rate ... key providers, ensuring timely resolution of escalated issues such as claims, contract interpretation, and provider data accuracy. + Negotiate settlements and… more
- Molina Healthcare (Austin, TX)
- …or other health care environment. * 3+ years experience in provider contract negotiations in a managed healthcare setting ideally in negotiating ... Provider Community that result in high quality, cost effective and marketable providers. Contract /Re-contracting with...5-7 years contract -related experience in the health care field including, but not limited to, provider… more
- Molina Healthcare (Fort Worth, TX)
- …with the Complex Provider Community that result in high quality, cost effective and marketable providers. Contract /Re-contracting with large scale entities ... cost control initiatives to positively influence the Medical Care Ratio (MCR) in each contracted region. * Leads...department and organization. * Oversees the maintenance of all Provider Contract templates including VBP program templates.… more
- The Cigna Group (Houston, TX)
- …total medical cost and quality. + Drives change with external provider partners by assessing clinical informatics and offering consultative expertise to assist ... reviews, and projects financial impact of larger or complex provider contracts and alternate contract terms. +...partners. + Intimate understanding and experience with hospital, managed care , and provider business models. + Team… more
- Centene Corporation (Austin, TX)
- …account management and accountability for issue resolution. Drive optimal performance in contract incentive performance, quality, and cost utilization. + Serve ... and align to performance-based agreements that incentivize better patient outcomes, cost -efficiency, and quality care . + Performance Management: Uses data… more
- CVS Health (Austin, TX)
- …contracting, provider issues/resolutions, related systems and information contained. * Provide guidance and share expertise to others on the team. * ... ourselves with dedicated colleagues who are passionate about transforming health care . As the nation's leading health solutions company, we reach millions… more
- Molina Healthcare (TX)
- …area.) **Job Qualifications** **REQUIRED EDUCATION** : Associate's Degree or equivalent provider contract , network development and management, or project ... customer service, provider service, or claims experience in a managed care setting. * Working familiarity with various managed healthcare provider … more
- Molina Healthcare (Houston, TX)
- …in HEDIS and quality initiatives. * Engages contracted network providers regarding cost control initiatives, Medical Care Ratio (MCR), non-emergent utilization, ... * 5-7 years managed healthcare administration experience. * Specific experience in provider services, operations, and/or contract negotiations in a Medicare and… more
- CVS Health (Austin, TX)
- …+ Provide excellent customer services for high volume inbound provider calls for the Claims Inquiry/Claims Research Medicaid team. Extensive claims research ... framework to make financial decisions to resolve provider issues. Explain provider 's rights and responsibilities in accordance with contract . + Process claim… more
- CVS Health (Austin, TX)
- …ourselves with dedicated colleagues who are passionate about transforming health care . As the nation's leading health solutions company, we reach millions ... escalations submitted by Aetna Network Account Management team or the Aetna Provider Contact Center. Concerns submitted vary- Claim inquiries, Retro contract … more
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