- Elevance Health (Tampa, FL)
- …functions within the specified region. + Develops provider networks that provide a competitive advantage. + Align contracting strategy with internal/external ... Provider Solutions provides strategic leadership in shaping and optimizing the provider experience, engagement and contracting for Behavioral Health business… more
- CVS Health (Tallahassee, FL)
- …audit readiness and collaborates with Compliance, Legal, Medicaid Health Plans, Network Contracting , and Provider Relations to ensure alignment with regulatory ... Director will also serve as a key liaison between Compliance, Legal, Network Contracting , and Provider Relations teams. **Required Qualifications** + A minimum… more
- CVS Health (Tallahassee, FL)
- …each and every day. **Position Summary** We are searching for an experienced provider network professional to support our plan sponsors in managing their provider ... as part of a cross functional team of clinicians and analysts that provide consultative information and create custom solutions for commercial Plan Sponsors. The… more
- Humana (Tallahassee, FL)
- …community and help us put health first** Humana Healthy Horizons is seeking a Medicaid Provider Materials Lead who is responsible for leading a team to execute core ... provider educational materials for Humana's Medicaid segment to drive...project management experience. + 3+ years of Medicaid or contracting experience. + Understanding of learning design principles and… more
- Centene Corporation (New Port Richey, FL)
- …experience. Two years of managed care or medical group experience, provider relations, quality improvement, claims, contracting utilization management, or ... Purpose:** Maintain partnerships between the health plan and the contracted provider networks serving our communities. Build client relations to ensure delivery… more
- Molina Healthcare (Orlando, FL)
- …limited to, Configuration, Business Systems, Encounters (inbound and outbound), Claims, Provider Services and Contracting . * Identifies issues, resolves problems ... **Job Description** **Job Summary** Provider Network Administration is responsible for the accurate...the accurate and timely validation and maintenance of critical provider information on all claims and provider … more
- Molina Healthcare (FL)
- …(eg, Provider Services/ Provider Inquiry Research & Resolution, Provider Contracting / Provider Relationship Management). + Provides timely, accurate ... **JOB DESCRIPTION** **Job Summary** Provider Network Administration is responsible for the accurate...the accurate and timely validation and maintenance of critical provider information on all claims and provider … more
- Molina Healthcare (Jacksonville, FL)
- …accordance with local Health Plan requirements * Works with Claims, Configuration, Contracting , Provider Data Management, and other business partners to resolve ... for leading, organizing and directing the activities of the Medicare Contracted Provider Post-Pay Claim Appeals and Disputes in accordance with the standards and… more
- Centene Corporation (Orlando, FL)
- …experience. Two years of managed care or medical group experience, provider relations, quality improvement, claims, contracting utilization management, or ... Purpose:** Maintain partnerships between the health plan and the contracted provider networks serving our communities. Build client relations to ensure delivery… more
- CVS Health (Tallahassee, FL)
- …+ Provide excellent customer services for high volume inbound provider calls for the Claims Inquiry/Claims Research Medicaid team. Extensive claims research ... on multiple platforms to assist providers with payment questions. + Educate provider with related information to answer the unasked questions, eg, additional plan… more