- Highmark Health (Pittsburgh, PA)
- …and payment strategy. The role also leads the strategy and creation of provider network designs and programs. The incumbent is responsible for understanding ... to drive provider performance in the domains of reimbursement and network programs. Specifically, the incumbent will lead the strategy and creation of… more
- Molina Healthcare (St. Petersburg, FL)
- …to business and system requirements of internal customers as it pertains to other provider network management areas, such as provider contracts. ... **Job Description** **Job Summary** Provider Network Administration is responsible for...* Receives information from outside parties for update of provider -related information in computer system(s). * Reviews/analyzes data… more
- Health Care Service Corporation (Huntsville, AL)
- …for the contracting, credentialing, and maintenance of professional provider data to support marketing, membership and network contracting across all ... internal provider meetings and work groups, researching problems related to provider credentialing, data and network participation. **Required Job… more
- AmeriHealth Caritas (Charlotte, NC)
- …working to resolve provider issues. ;Responsible for monitoring and managing provider network by assuring appropriate access to services throughout the ... positive working relationships between Plan and its contracted providers. ;Assigned provider accounts may include single or multiple practices in single or… more
- Centene Corporation (Frankfort, KY)
- …databases and reports to monitor network compliance with State requirements. The Provider Data Management Specialist I position is primarily remote, with ... and ad hoc basis and ensure state compliance + Provide appropriate reports and statistical data to...**Education/Experience:** High school diploma or equivalent. 2+ years of provider data or network administration… more
- Molina Healthcare (Augusta, GA)
- …and system requirements of customers as it pertains to contracting, network management and credentialing. **Knowledge/Skills/Abilities** * Strategically plans, ... functions. * Directs the development, implementation and maintenance of provider data in the claims payment system....and implementing appropriate Corrective Action Plans for submission of provider network files, etc. * Engages with… more
- Seattle Children's (Seattle, WA)
- We are seeking a dedicated **Advanced Practice Provider (Nurse Practitioner or Physician Assistant)** to join our Child Protection Team. This part-time position ... independent and team-based clinical practice and consultation in the evaluation and management of pediatric patients referred for possible child abuse and neglect.… more
- Molina Healthcare (Buffalo, NY)
- …requirements of customers as it pertains to contracting, network management and credentialing. **KNOWLEDGE/SKILLS/ABILITIES** + Generates data to support ... continuous quality of provider data and developing SOPs and/or BRDs. + Develops and...**Required Education** + Bachelor's Degree in business administration, healthcare management , or a related field; or equivalent combination of… more
- St. Luke's University Health Network (Allentown, PA)
- …we serve, regardless of a patient's ability to pay for health care. The Network Provider Services Auditor performs audits as part of the Documentation and ... and accurate accounting of time allocated to each audited provider . + Analyzing data in Excel or...as strong written/verbal communications skills preferred. Strong computing and data management abilities, analytical, and interpersonal and… more
- The Cigna Group (Bloomfield, CT)
- …years in healthcare operations, provider services, or contracting. + Familiarity with provider data management systems (eg, HCPM, CPF-Central Provider ... each regulatory entity. The ideal candidate brings expertise in data analysis, project management , and healthcare operations,...timely and accurate submission of state-mandated reports related to network adequacy and provider data .… more