- The Cigna Group (Oklahoma City, OK)
- …of the Provider Contracting Team and reports to the Provider Contracting Senior Manager. This role assists in developing the strategic direction and management ... of communication with matrix partners including but not limited to, Claims Operations, Medical Management. Credentialing, Legal, Medical Economics, Compliance, Sales… more
- Highmark Health (Pittsburgh, PA)
- **Company :** Highmark Inc. **Job Description :** **JOB SUMMARY** The Senior Vice President (SVP) of Medicaid is responsible for the overall strategic direction, ... across all aspects of the Medicaid business, including member enrollment, claims processing, care management, and quality improvement. Implement best practices to… more
- The Cigna Group (Cleveland, OH)
- …of communication with matrix partners including but not limited to, Claims Operations, Medical Management. Credentialing, Legal, Medical Economics, Compliance, Sales ... Experience in developing and managing key provider relationships including senior executives. + Knowledge of complex reimbursement methodologies, including incentive… more
- UHS (Johnson City, NY)
- …eligibility and authorization requirements are met + Acts as a patient advocate when communicating with insurance providers, helping to ensure timely access to ... assisting in the reconsideration and appeals process for denied claims + Collaborates with clinical and administrative teams to...recognition, and initiatives like Walk in my Shoes for senior leaders are just a few ways we foster… more
- Amazon (Sunnyvale, CA)
- …cross-functional business reviews. This requires that the Business Manager be both an advocate for the supplier within Lab126 and be their harshest critic to ensure ... managing the business relationship including contracts, pricing, terms and conditions and claims . Must be an effective negotiator. The value of these supplier… more
- McLaren Health Care (Indianapolis, IN)
- …at the most appropriate and cost-effective setting. Performs as the member advocate with emphasis on education regarding managed care, disease management and PCP ... risk, and under and overuse of services. Collaborates with Medical Director and senior management on complex cases and special projects. **This position is hybrid… more
- Chapa-De (Auburn, CA)
- …and AAAHC. + Oversee investigations into compliance violations, safety incidents, and legal claims in collaboration with HR and legal counsel. + Educate leaders and ... reports on risk trends, mitigation activities, and audit findings to senior leadership. Required Experience: MINIMUM QUALIFICATIONS: + Bachelor's degree in… more