- Healthfirst (NY)
- …+ Responsible for case development and resolution of clinical cases, such as: Pre-existing Conditions, Prior Approval, Medical Necessity, Pre-certification, Continued ... Stay, Reduction, Termination, and Suspension of services. The end to end process requires the Specialist to independently: + Research issues + Reference and understand HFs internal health plans policies and procedures to frame decisions + Interpret regulations… more
- Healthfirst (NC)
- …roles, people leader roles, business analytics, workforce effectiveness and other areas. Healthfirst is committed to the well-being of its employees, offering an ... & Accident Insurance, Flexible Reimbursement Accounts, Employee Assistance Plan, Healthfirst 401(k) plan, and much more. Should you join...Agent Class. Thank you for considering a career with Healthfirst . We look forward to the possibility of you… more
- Healthfirst (NY)
- …with team members and other stakeholders. Effectively communicate program expectations to Healthfirst and vendor stakeholders in a timely and clear fashion. + Act ... managing regular QA processes related to communications sent on Healthfirst 's behalf to member and providers, as well as...as facilitating scheduled or ad hoc audits done by Healthfirst or other external experts. Develop and maintain … more
- Healthfirst (NY)
- …+ Understand claim payments and impact of fee-schedule updates from State/CMS. + Assist and monitor direct payment initiatives from the state for Provider ... Organizations + Responsible for contract analysis and fee schedule modeling. + Maintain current project logs and work plans on assignments. + Create and maintain database for fee schedules changes. + Collaborate and Coordinate with teams in Finance for all the… more
- Healthfirst (NY)
- …+ Utilize established workflows and procedures for multistate payroll operations. Ensure compliance and accuracy of payroll tax processing + Reconciliation and ... analysis of tax data + Preparation of tax funding where required + Identification and/or resolution of payroll issues as they arise + Verify system tax calculations, and update tax rates in Workday as required + Research and resolve assigned payroll tax… more
- Healthfirst (NY)
- …improvement, prioritizing projects, and building critical relationships with other Healthfirst departments + Builds sustainable relationships of trust through open ... and interactive communication with internal and external customers + Additional duties as assigned **Minimum Qualifications:** + HS diploma or GED + Working experience in a fast-paced environment + Proficient in Microsoft Office Suite applications including… more
- Healthfirst (NY)
- …teams to relink cases that have active coverage but are not linked to Healthfirst plans in the system by providing proof of services. Assist the Disenrollment team ... in reviewing all membership that has inactive Medicaid coverage by assisgning case to be worked on by the Entitlement Advocate team and following up on them weekly until they are Eligible/active. Has full and complete access to patient records and reports as… more
- Healthfirst (Enfield, NY)
- …home visits per day (clustered in small geographic areas) Supports the Healthfirst clinical team members, including UAS nurses and Care Managers, by facilitating ... needed, escalates member questions, as directed Properly documents findings in Healthfirst information systems Collaborates with other members of the clinical team… more
- Healthfirst (NY)
- …Scope, plan, and oversee project tasks, timelines, deliverables, and the internal and external people engaged in multiple projects Works in deep partnership and daily ... collaboration with the OD program or project lead ensuring an agreed upon, timely, flawless delivery Coordination of a variety of tasks which make enterprise-wide employee development programs run flawlessly, such as building and managing rosters, scheduling… more
- Healthfirst (PA)
- …+ Maintains tracking tools to log audit results including areas of non-compliance and informing what areas of improvement are needed for discussion with management ... and/or at departmental team meetings + Assists with evaluating and analyzing aggregate quality performance data + Develops strategies for business performance improvement initiatives. This includes: identifying opportunities for improvement, problem… more
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