- NTT DATA North America (Montgomery, AL)
- …the full system life cycle of assigned projects. The focus will be the Medicaid Claims Processing System. The Senior BA will support both the current MMIS and ... plan for the future CPMS takeover project working with the Project Manager, client and vendor development team to build out the implementation steps. This will include the overall Schedule, Work Plan, security, testing, systems integration, deployment… more
- CVS Health (Monroeville, PA)
- …and partnering with account managers as needed in order to ensure accurate claims processing + Manage the Pharmacy benefit SalesForce.com Specialty Pharmacy ... Reimbursement queue ensuring timely review, resolution, and response + Resolve escalated PBM Client questions and / or issues independently + Identify trends within SalesForce.com case requests and escalate to management as necessary **Required… more
- Conduent (Chesapeake, VA)
- …navigating multiple systems and may also assist with back-office tasks like claims processing and general administrative work. Your strong communication skills, ... reliability, and ability to deliver excellent customer service will help create a positive experience for every caller. **Requirements:** We're looking for candidates with strong customer service skills and natural empathy. To succeed in this role, you must… more
- UPMC (Pittsburgh, PA)
- …terminology and coding. + In-depth knowledge of electronic data interchange and claims processing , third party payer rules, reimbursement practices and ... regulatory guidelines. + Proficient with MS Word, Excel and Outlook. + Excellent client service skills. + Excellent written and verbal communication skills. + Ability to coordinate projects to meet the needs of users and establish priorities, make decisions… more
- Henry Ford Health System (Troy, MI)
- …policies and procedures. Major areas of responsibility include oversight of the claims processing system, development of new benefit designs and programs, ... organizing the prior authorization process and management of the various vendor/customer relationships. EDUCATION AND EXPERIENCE:High School Diploma. Associate Degree or higher is preferred. One year of pharmacy benefit management experience or the equivalent.… more
- Ivyhill Technologies LLC (Bethesda, MD)
- …in Utilization Management, Referral Management, Authorization/Denials, or Medical Claims Processing /Insurance Referral. Additionally, qualified candidates must: ... + Be a US Citizen. + Have the knowledge, skills, and computer literacy to interpret and apply medical care criteria, such as InterQual, Milliman Ambulatory Care Guidelines, Specialty Referral Guidelines (SRGs) or other evidence-based guidelines identified by… more
- Public Consulting Group (Santa Fe, NM)
- …+ Third Party Administrator Services + Enhance Health and Public Safety Services + Claims Processing Services and Solutions + Consulting and Advisory Services + ... Cost Allocation Plans and Time Studies + Cost Settlement and Supplemental Payment Strategies + Healthcare Access and Markets A Test Leader oversees the testing process, developing test strategies and plans, guiding a team of testers, and collaborating with… more
- AbbVie (North Chicago, IL)
- …degree or comparable experience in Healthcare Finance, Revenue Cycle, Insurance Claims Processing and/or Specialty Pharmacy Operations. + Individuals must ... meet applicable Pharmacy Technician Licensure and Certification requirements no later than the first day of employment. + 5-7 years' experience within a healthcare provider, PBM, Specialty Pharmacy or Retail/Mail Order Pharmacy setting, familiarity with… more
- Dignity Health (Henderson, NV)
- …codes to individual patient health information records for data retrieval analysis and claims processing . + This position is expected to perform duties in ... alignment with the mission and policies within the Dignity Health organization TJC CMS and other regulatory agencies. + Analytical / Critical thinking and problem solving. + Excellent written and verbal communication skills including the ability to present… more
- Health Care Service Corporation (Philadelphia, PA)
- …experience. + Extensive knowledge of provider and facility contracting, products, and claims / processing systems. + Leadership skills to oversee staff, implement ... initiatives, and work across the company to resolve issues. + Negotiation skills. + Relationship building skills. + Knowledge of marketplace. + Meet deadlines and work well under pressure. + Verbal and written communication skills to interact with all levels… more
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