- Martin's Point Health Care (Portland, ME)
- …system to document records of annual primary source verification activities, ensuring compliance with regulatory requirements. + Maintains a robust medical ... on HEDIS performance for internal and external stakeholders, management, and regulatory bodies. + Maintains detailed project documentation in accordance with the… more
- GMHC (New York, NY)
- …role ensures operational excellence, strong interdepartmental communication, program integrity, and compliance with all regulatory and contract requirements. The ... and SURE Housing program. These programs are integrated with case- managed services, financial coaching, behavioral health supports, and community partnerships… more
- Community Health Systems (Franklin, TN)
- …while meeting productivity and quality standards. + Knowledge of regulatory compliance , including HIPAA, FDCPA, and applicable healthcare finance laws. We ... outstanding insurance balances, identifying claim issues, and ensuring timely resolution in compliance with government and managed care contract terms. This role… more
- Sanofi Group (Morristown, NJ)
- …and timely statistical programming deliverables within a project, ensure technical validity, compliance to internal standards and SOPs, regulatory requirements + ... in Oncology and/or Neurology. We are an innovative global healthcare company with one purpose: to chase the miracles...needs, seek to optimize resource utilization thru efficient and well- managed resource allocation and across projects or areas +… more
- Humana (Springfield, IL)
- …inquiries, concerns, or problems associated with claims payment to adhere to Managed Care contract requirements and to optimize provider experience and satisfaction ... submission processes, coding, and/or dispute resolution and/or other related functions in healthcare /health insurance + Experience with IL Medicaid and FIDE D-SNP +… more
- The City of Houston (Houston, TX)
- …public right-of-way. + Reviews and administers banner district applications, ensuring compliance with City standards. + Oversee a comprehensive database tracking ... / real estate documentation experience. A valid Texas Driver's License and be in compliance with the City of Houston policy on driving. (AP 2-2). **Preference shall… more
- RWJBarnabas Health (Jersey City, NJ)
- …to ensure high quality care and patient centered safety programs + Maintains compliance with all relevant legislative and regulatory rules and requirements ... and objectives + Promote collaborative, positive working relationships with other healthcare providers, payers, governmental and regulatory agencies + Ensure… more
- CareOregon (Portland, OR)
- …organizational strategic priorities. + Ensures effective operations and measurements, including compliance and regulatory reporting of required activities under ... effective teams + Minimum 5 years' experience in the managed care or healthcare industry Preferred +...economic impact of business decisions + Strong understanding of managed care, health care, and relevant regulatory … more
- Humana (Lansing, MI)
- …interactions with Humana's Michigan Medicaid plan related to claims. + Ensure compliance with Michigan's Managed Care Contractual requirements for provider ... and analyzing large sets of claims data. + Knowledge of Medicaid regulatory requirements. + Excellent written and verbal communication skills. + Proficiency in… more
- Sutter Health (Jackson, CA)
- …guidelines. + Strong understanding of the trends and issues affecting the healthcare industry, including managed care, clinical integration and quality outcomes. ... organizational performance improvement skills, in-depth working knowledge of integrated healthcare organization and administration, agency standards/ compliance , and… more