- HCA Healthcare (Asheville, NC)
- …as an educational resource to patients, families, interdisciplinary team members, payer representatives, and other parties as appropriate about behavioral services. ... + Reviews, coaches, and helps with the training of new staff/interns as assigned within approved practice and program guidelines. Participates in developing department goals and clinical programming. + Performs utilization review as assigned. + Helps with… more
- NTT DATA North America (PA)
- …a Health care processing (Provider Data Management preferred, Claims or other Healthcare Payer / Provider experience) + 3+ years of experience using a computer with ... Windows PC applications that required you to use a keyboard, navigate screens, leverage internet search engines, and other web based applications. **Preferred Skills/Experience:** + Experience in Provider Data Management and/ or Provider Credentialing +… more
- Datavant (Sacramento, CA)
- …Capacity will provide strategic leadership and long-term planning for all Payer WFM programs supporting multi-site, multi-channel and Global contact center ... operations. This leader will own the end-to-end forecasting, capacity planning, scheduling strategy, and workforce technology ecosystem to ensure the organization can meet service, efficiency, and growth objectives. The Director will oversee a high-performing… more
- Highmark Health (Boise, ID)
- …combination of experience and education **Preferred** + 6 years of experience in payer , hospital system, or care delivery industry + Experience influencing change in ... complex organizational systems **SKILLS** + Ability to solve complex conceptual and operational problems; potential ability to lead teams in problem-solving exercises + Strong quantitative and analytical skills + Demonstrated influencing, and teamwork skills +… more
- WMCHealth (Kingston, NY)
- …of multiple 3rd party payers. Utilizes tools available including websites, payer meetings, educational seminars and provider reps. + Processes credit card ... balances and issues refund requests where appropriate. + Promotes positive relationships among co-workers. Communicates effectively within the department and keeps management informed on key issues. + Performs other duties as assigned.… more
- Centene Corporation (Springfield, IL)
- …management activities to ensure compliance with current state, federal, and third-party payer regulators + Provides and/or facilitates education to members and their ... families/caregivers on disease processes, resolving care gaps, healthcare provider instructions, care options, referrals, and healthcare benefits + Partners with leadership team to improve and enhance care and quality delivery for members in a cost-effective… more
- Highmark Health (Lincoln, NE)
- …data + 3 years of project leadership in a complex, matrixed environment ( payer and/or provider preferred) + 3 years of providing analytical consultation to clinical, ... administrative, operational and financial stakeholders **Preferred** + Applied experience analyzing Social Determinants of Health (SDOH) data + Experience developing analytic applications or dashboards (eg,RShiny, Tableau) to support self-service analytics +… more
- UPMC (Pittsburgh, PA)
- …experience, and/or legal experience, preferably on the insurance ( payer ) side preferred. + Pennsylvania-specific compliance experience preferred.Licensure, ... Certifications, and Clearances: + Act 34 UPMC is an Equal Opportunity Employer/Disability/Veteran more
- Beth Israel Lahey Health (Boston, MA)
- …for scheduled visit and documents in the system. Document appropriate payer information, including worker's compensation and auto liability. + Informs patient ... of necessary preparation for scheduled visit, including providing documents, films and notes from other providers, required preparation and protocol for diagnostic tests and procedures. + Coordinates and interprets multiple data sets required for efficient… more
- Billings Clinic (Billings, MT)
- …of CMS requirements and readmission penalties. *Maintains working knowledge of insurance/ payer benefits. Evaluation *Monitors the need for revisions in the plan ... of care and makes recommendations to the multidisciplinary/healthcare team when indicated. Modifies the plan of care/goals to reflect changes in patient or their support system status and needs. *Monitors, evaluates and documents patient progress related to… more
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