- Sharp HealthCare (San Diego, CA)
- …and responding to internal and external benefit inquiries, and supporting claims testing activities. Provides training to new and less experienced Benefit ... insurance product implementation, benefit/coverage policy development, benefit configuration, or claims role. **Other Qualification Requirements** + Bachelor's degree in… more
- Molina Healthcare (Hartford, CT)
- …submissions to Regulators. * Leads efforts through local Data/Business Analysts to audit provider contract loads and claims payments to ensure compliance ... Plan's operational departments, programs and services, in alignment with Molina Healthcare 's overall mission, core values, and strategic plan and in compliance… more
- Molina Healthcare (Caldwell, ID)
- …for accurate and timely maintenance of critical provider information on all claims and provider databases. Maintains critical provider information on all claims ... timely manner to meet department standards of turnaround time and quality. + Audit loaded provider records for quality and financial accuracy and provide documented… more
- Molina Healthcare (Scottsdale, AZ)
- …you keep complaint data synchronized across appeals & grievances, enrollment, claims , pharmacy, and quality functions. You surface systemic issues, steer partners ... durable fixes, and convert disciplined CTM management into Stars gains, audit readiness, and measurable member-experience improvements. You'll begin as a senior… more
- Aveanna Healthcare (Chandler, AZ)
- …Medical Billing/Collections Salary: $18.00 - $19.00 per hour Position Details Aveanna Healthcare is the largest provider of home care to thousands of patients ... to fulfill our mission to revolutionize the way pediatric healthcare is delivered, one patient at a time. At...all guarantors for services provided. This is inclusive of claims to commercial, Medicare, Medicaid and private pay accounts.… more
- Robert Half Technology (Martinez, CA)
- Description Our healthcare client is seeking a dynamic Project Manager - Strategic Initiatives to support the CEO and executive leadership team in advancing critical ... Collaborate with diverse groups including IT, Quality, Medical Directors, Claims & Processing, and Utilization Management. Support governance activities with… more
- Molina Healthcare (Nampa, ID)
- …with various internal customers (eg, Provider Services, Contracting and Credentialing, Healthcare Services, Member Services, Claims ) to gather documentation ... order to maintain coding accuracy and excellence. The position also entails producing audit reports for internal and external review. The position may also work with… more
- Commonwealth Care Alliance (Boston, MA)
- …maintaining ETL workflows and data integration processes. + Strong understanding of healthcare data, including claims , encounters, diagnoses, and provider data. ... of data workflows, business logic, and submission policies. + Partner with IT, claims , and enrollment teams to improve systems integration and enhance the risk… more
- Robert Half Technology (New York, NY)
- …audits. * Strong knowledge of compliance frameworks such as HIPAA, HITRUST, and healthcare audit practices. * Proficiency in Microsoft Project, Excel (including ... Description We are looking for a skilled Healthcare Project Manager to lead critical initiatives within...requires a strategic thinker with a strong background in healthcare operations and project management, capable of driving cross-functional… more
- Molina Healthcare (Lexington, KY)
- …EXPERIENCE/KNOWLEDGE, SKILLS & ABILITIES:** * 7+ years experience in managed healthcare Quality/HEDIS project management and HEDIS Audit * Demonstrated ... Improvement function oversees, plans, and implements new and existing healthcare quality improvement initiatives and education programs; ensures maintenance of… more