- Sutter Health (Vallejo, CA)
- …experience. **SKILLS AND KNOWLEDGE** + Knowledge of third-party regulations and requirements, managed care concepts and current practices. + Familiarity with ... Federal/State and JCAHO requirements for registration. + Demonstrated analytical and problem-solving skills, as well as having verbal and written communications skills. + Leadership skills, including team building, and coaching/mentoring with the ability to… more
- FlexStaff (Chappaqua, NY)
- …experience in physician medical billing, specifically with Medicare Part B and in-network Managed Care . * Familiarity with medical coding modifiers and handling ... denied claims for trends and issues, reporting findings to the Senior Team Lead . * Daily Correspondence: Review and address daily correspondence effectively. * Data… more
- Emory Healthcare/Emory University (Atlanta, GA)
- …that address opportunities to enhance EHC's operating margin. + Assume a lead role in decision support implementation projects. + Train and mentor employees ... _Regular Full-Time_ **Job Number** _152859_ **Job Category** _Revenue Cycle & Managed Care_ **Schedule** _8a-5p_ **Standard Hours** _40 Hours_ **Hourly Minimum**… more
- BeOne Medicines (San Mateo, CA)
- …regulatory advice on appropriate relationships with healthcare professionals, patients, managed care entities, advocacy organizations, and government entities, ... as part of the Labeling Working Group. + Serve as the lead regulatory representative on various cross-functional teams, including promotional and medical review… more
- Molina Healthcare (Savannah, GA)
- …5 years in healthcare, with 2+ years in health plan quality improvement or managed care . (HIGHLY PREFERRED)** + **Strong knowledge of NCQA standards and EQRO ... and problem-solving. + Strong oral and written communication. + Ability to lead cross-functional teams and manage multiple priorities. + Detail-oriented with a focus… more
- Molina Healthcare (Fort Worth, TX)
- …and secondary), Provider Contracting, and Benefit Configuration processes. + Experience with Managed Care + Experience with TX Medicaid/CHIP and TX Directed ... documentation. + Generate and distribute standard reports on schedule + Maintain and lead program status meetings on a regular cadence, and any needed ad-hoc… more
- Centene Corporation (Harrisburg, PA)
- …processing, provider billing, or provider relations experience, preferably in a managed care environment. Knowledge of provider contracts and reimbursement ... trends in claims processing issues and identify work process solutions + Lead meetings with various departments to assign claim project priorities and monitor… more
- Molina Healthcare (Madison, WI)
- …or equivalent combination of relevant education and experience + Medicare and/or Medicaid Managed Care experience + Quantitative aptitude + Strong leadership in ... intelligence, and regulatory changes to inform strategic decisions. + Lead high-priority, cross-functional projects across the Medicare Business Unit from… more
- US Tech Solutions (Newark, NJ)
- …New Jersey Registered Nurse (RN) License required.** **Skills:** + Knowledge of managed care principles and medical terminology. + Familiarity with HEDIS ... initiatives. + Assist with clinical studies, quality projects, and audits. + Lead and coordinate Corrective Action Plans (CAPs) and follow-up reaudits. + Represent… more
- Centene Corporation (Indianapolis, IN)
- …abuse experience. Thorough knowledge of medical terminology. Previous experience in managed care environment and as a lead or supervisor of staff, including ... hiring, training, assigning work and managing performance preferred. Knowledge of Microsoft Excel, medical coding, claims processing, and data mining preferred. **Please note:** candidate must reside within the state of Indiana. Pay Range: $86,000.00 -… more