- Diversicare Healthcare Services & Diversicare Ther (Tupelo, MS)
- …(ie: certifications, denial letters, skilled documentation, coverage criteria, etc ) 15. Provides Managed Care case management at the center level. 16. Reviews ... Activities. 19. Continues to update knowledge base related to Medicare, Managed Care , Medicaid, RAI Process and computer technology updates. 20. May be… more
- Caz Recovery (Buffalo, NY)
- …the financial pre-approval processes, which includes but is not limited to Managed Care Organizations (MCO), Department of Social Services (DSS), Supplemental ... the agency's database. * Ensures prospective residents have an active in-network Managed Care Organization (MCO) or assists applicants in need of Medicaid … more
- Dignity Health (Bakersfield, CA)
- …management or team leadership experience. + Strong working knowledge of managed care contracts, provider reimbursement methodologies, and recovery-related ... provider relations workflows + Knowledge of Medicare Advantage, Commercial, and Medi-Cal managed care recovery requirements. **Where You'll Work** The purpose of… more
- Trinity Health (Livonia, MI)
- …MSOW database and ensures mailing addresses, telephone numbers, participation in various managed care organizations, and other key demographics are up to ... Fields telephone calls and monitors shared email inbox regarding managed care products, application requests, credentialing/recredentialing procedures, etc.… more
- AmeriHealth Caritas (Charleston, SC)
- …Degree or equivalent experience preferred with emphasis in health services administration, managed care , or equivalent experience required + Minimum **five (5) ... years** of management experience in a managed care setting, managing teams and projects **required** + Minimum **five (5) years** of experience in healthcare… more
- AmeriHealth Caritas (Newtown Square, PA)
- …and insights + At least ten (10) or more years of experience in managed care operations/administration + Working knowledge of CMS guidance and experience with ... history of success in triaging, resolving, and optimizing cross-functional processes within managed care organizations + Ability to work collaboratively with… more
- Tenet Healthcare (Commerce Township, MI)
- …charges (eg, ABN not signed, denials, disputes, bad debt). 4. Reviews proposed managed care contracts and identify any issues or concerns with implementation ... loaded correctly into IMaCs and claims properly adjudicated during and after managed care negotiations. 6. Monitors/reviews billing, A/R and reconciliation for… more
- HCA Healthcare (Nashville, TN)
- …support to various teams, including payer contracting and analytical teams, payer relations, managed care , legal support, and service line leaders. Your primary ... best practices when collaborating with customers and peers. + Assist the Payor Relations Managed Care teams and Managed Care Legal teams in proactively… more
- J&J Family of Companies (Fresno, CA)
- …to address critical access and affordability issues for patients. + Partner with managed care colleagues to understand current policies and potential future ... solutions across multiple payer types and plans (ie, Medicare, Medicaid Managed Care , Commercial). + Execute business in accordance with the highest ethical,… more
- CVS Health (Hartford, CT)
- …handling financial data - claim, revenue, restatement, etc. + Prior experience in Medicaid managed care and/or value based care , or medical underwriting. ... Knowledge of managed care , provider contracts and provider reimbursement methodologies. + Understanding...provider contracts and provider reimbursement methodologies. + Understanding of managed care and how provider reimbursement policies… more