- AmeriHealth Caritas (Charleston, SC)
- …reimbursement set up. + Ensure that provider payment issues submitted by Provider Network Management or any other source are validated, researched and ... job is to be responsible for the maintaining current provider data and provider reimbursement set up,...healthcare claims payment configuration process/systems and its relevance/impact on network operations . + 1 to 2 years… more
- Humana (Little Rock, AR)
- …Pricer Business and System Support team responsible for administering complex Medicaid provider reimbursement methodologies. The associate will support existing ... be primarily responsible for implementation, maintenance and support of Medicaid provider reimbursement for hospitals and facilities....closely with IT, the pricing software vendor, CIS BSS, Medicaid operations , claims operations , and… more
- CVS Health (Chicago, IL)
- …benefits and/or contract interpretation * Medicaid Regulatory Standards for Network Access, Credentialing, Claims Processing, Provider Appeals & Disputes ... Drives the implementation of internal and external solutions to achieve provider satisfaction, cost targets, utilization/performance, network growth, and… more
- CVS Health (Trenton, NJ)
- …others at all levels + Knowledge of Medicaid Regulatory Standards for Network Access, Credentialing, Claims Processing, Provider Appeals & Disputes and ... State requirements. + Evaluates, helps formulate, and implements the provider network strategic plans to achieve value-based...Network Value Based Contacting experience with 2-3 years Medicaid Network experience + Must have Microsoft… more
- Humana (Baton Rouge, LA)
- …of how organization capabilities interrelate across segments and/or enterprise-wide. The Medicaid Regional VP, Health Services will provide medical leadership ... cases (acute care hospital, LTAC, Acute rehab, SNF) according to the Humana Medicaid Model of Care. *Participate in Quality Operations including chair Quality… more
- Highmark Health (Pittsburgh, PA)
- …the market. Partner with and provide both strategic and tactical direction to the provider network contracting team to build and enhance the provider ... SUMMARY** This job leads the overall performance of a Medicaid plan, for quality of care and service as...maintaining strategic relationships within the assigned state, the care provider partners, key vendors, and the community at-large. The… more
- Humana (Baton Rouge, LA)
- …to produce requested or required data elements. This role will support our Medicaid Clinical operations in multiple markets. This role manages recurring ... **Become a part of our caring community and help us put health first** The Medicaid Data and Reporting Analyst integrates data from multiple sources… more
- Elevance Health (Indianapolis, IN)
- …Serves as a clinical pharmacy resource to pharmacy benefit management and pharmacy operations teams. + Ensures compliance of the Medicaid formularies with ... ** Medicaid Formulary Pharmacist Clinical - CarelonRx** **Location:** This...management processes. + Responsible for all member, stakeholder, and provider communications regarding formulary changes. + Ensures appropriate formulary… more
- AmeriHealth Caritas (Detroit, MI)
- **Role Overview:** ;The Provider Network Operations Data Analyst plays a key role in maintaining accurate provider data and fostering strong ... across Medicaid , Medicare, and Exchange products. This role ensures provider information is correctly represented in all operating systems and serves as… more
- Molina Healthcare (ID)
- …trends or other issues related to medical care costs. + Work with clinical, provider network and other personnel to bring supplemental context/insight to data ... on developing financial models to evaluate the impact of provider reimbursement changes + Provide data driven... data driven analytics to Finance, Claims, Medical Management, Network , and other departments to enable critical decision making… more