- Highmark Health (Pittsburgh, PA)
- …and payment strategy. The role also leads the strategy and creation of provider network designs and programs. The incumbent is responsible for understanding ... accountable for any program or strategic tactic to drive provider performance in the domains of reimbursement and ...provider performance in the domains of reimbursement and network programs. Specifically, the incumbent will lead the strategy… more
- AmeriHealth Caritas (Harrisburg, PA)
- **Role Overview:** The Provider Network Contract Representative oversees the daily operations related to Out of Network (OON) agreements, provider ... applications. This role ensures the timely and accurate processing of provider agreements and supplemental packets, maintains detailed records, and supports… more
- St. Luke's University Health Network (Allentown, PA)
- …Contacts Insurance Payers to provide Notice of Admission on behalf of PG provider to secure reimbursement for Observation and Inpatient Services. + Refe rs a ll ... reimbursement. The intent of this job description is to provide a summary of the major duties and responsibilities...Advocacy Department. + Identify patients scheduled with Out of Network Health Plans and refer patient to central scheduling… more
- St. Luke's University Health Network (Easton, PA)
- …our PCA's to provide top quality care to our patients. The Network Float (Central Staffing) PCA is an experienced professional motivated by the challenge of ... every situation. The St. Luke's Central Staffing Department provides support to the Network Campuses as necessary to ensure appropriate staffing levels which allow… more
- St. Luke's University Health Network (Easton, PA)
- …situation. The St. Luke's Central Staffing Department provides support to the Network Campuses as necessary to ensure appropriate staffing levels which allow our ... nurses to provide top quality care to our patients. The Central...providing care to patients in nursing settings across the network . This professional must posses a multi-disciplinary skill set… more
- 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, ...loading and submissions and interface with matrix partners for network implementation and maintenance. + May provide … more
- AmeriHealth Caritas (Newtown Square, PA)
- …makes available to the local markets. A deep understanding of network contracting strategies, credentialing, value-based compensation, provider data management ... essential, as well as a expertise related to how network operations and provider data integrity impacts...outcomes and reduce redundancy between the local and corporate Network teams. ; **Organizational Leadership:** + Provide … more
- Magellan Health Services (PA)
- …supportive provider experience. + Act as liaison between Clinical, Quality, and Network and the provider community, sharing provider feedback to internal ... position is responsible for building, maintaining and enhancing relationships with network providers by sharing performance, quality, and other value-based data.… 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 ... of care to our members. Engage with providers to align on network performance opportunities and solutions, and consultative account management and accountability for… 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