- Centene Corporation (Newark, NJ)
- …Medical Home initiatives + Perform detailed HBR (Health Benefits Ratio) analyses, Health Information data Information Set (HEDIS) analyses, and create ... ensuring a coordinated effort in improving financial and quality performance + Provide information and status updates for providers regarding incentive… more
- Sanford Health (SD)
- …**Weekly Hours:** 40.00 **Salary Range:** $27.50 - $44.00 **Job Summary** The Senior Provider Relations Specialist (SPRS) is responsible for acting as a resource ... to the Provider Experience, Provider Relations team, and providers....assigned subject matter. Has in depth knowledge on the information system application(s) and a basic working knowledge of… more
- Blue Cross Blue Shield of Massachusetts (Hingham, MA)
- …medical records, and apply clinical coding expertise to evaluate appropriateness of provider documentation and coding. + Compile data and present solutions ... for performance improvement and further education. + Summarize and provide feedback to risk adjustment and/or provider ...is a key part of associate wellbeing. For more information on how we work and support that work/life… more
- Molina Healthcare (New York, NY)
- …Maintains critical provider information on all claims and provider databases. Synchronizes data among multiple claims systems and application of ... are responsible for accurate and timely maintenance of critical provider information on all claims and ...business rules as they apply to each database. Validate data to be housed on provider databases… more
- Highmark Health (Albany, NY)
- …to and collaborates with the analytics team to ensure reports are accurate, and provide meaningful, actionable data . Provide assistance to providers in the ... _As a component of job responsibilities, employees may have access to covered information , cardholder data , or other confidential customer information that… more
- Molina Healthcare (Tacoma, WA)
- …is responsible for the accurate and timely validation and maintenance of critical provider information on all claims and provider databases. Staff ... such as provider contracts. **KNOWLEDGE/SKILLS/ABILITIES** + Generates and prepares provider -related data and reports in support of Network Management and… more
- Molina Healthcare (Detroit, MI)
- …is responsible for the accurate and timely validation and maintenance of critical provider information on all claims and provider databases. This ... and effective utilization of implemented solutions + Generates and prepares provider -related data and reports in support of Network Management and Operations… more
- Fallon Health (Worcester, MA)
- … Provider enrollment initiatives. + Escalate critical issues and conflicts to Manager, Provider Data or Sr. Director, Benefit and Provider Configuration ... Maintain detailed documentation within QNXT cases. Conduct proactive follow-up activities with provider and/or Fallon Health staff. + Validate data received by… more
- Molina Healthcare (Naperville, IL)
- …maintenance of critical provider information on all claims and provider databases. Synchronizes data among multiple claims systems when applicable, and ... business rules as they apply to each database. Validate data to be housed on provider databases...and coordination of amendments, reimbursement, and language changes. Requests information of billing codes, services provided and other … more
- Corewell Health (Grand Rapids, MI)
- This position is a fully remote position. Job Summary Drive provider network strategies and solutions to improve outcomes and decrease medical expense trends. ... + Responsible for contributing to the development and execution of provider strategy and solutions for assigned Accountable Care Networks. Substantially responsible… more