• Investigations Consultant

    Highmark Health (Providence, RI)
    …reports, graphs, and charts to timely identify trends and patterns of potential healthcare fraud, waste and abuse. Communicate findings to company management of ... + Maintain current case related information on all applicable case management tracking systems. + Provide investigative support and mentoring to investigative… more
    Highmark Health (05/07/24)
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  • Manager Provider Contract Development

    Highmark Health (Providence, RI)
    …following + 5 - 7 years in the Healthcare Industry + 5 - 7 years in Management + 5 - 7 years in Contract Development + 1 - 3 years in Legal **Preferred** + None ... :** **JOB SUMMARY** This job manages the business process of contract management with internal departments. The incumbent oversees the staff and facilitates the… more
    Highmark Health (05/15/24)
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  • Product Evaluation Research Manager

    Highmark Health (Providence, RI)
    …and insights timelines and deliverables within the MEP. Broad stakeholder management including product owners, vendor and industry partners, clinicians, analytic ... **Required** + 5 years work experience, with some exposure to innovation or healthcare related fields, OR + 3 years work experience post graduate degree, with… more
    Highmark Health (04/19/24)
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  • Associate Hierarchical Condition Category (HCC)…

    Highmark Health (Providence, RI)
    …through the assignment of appropriate ICD-10 diagnosis codes under the direction of management ; may flex between coding projects with different MA, ESRD, or ACA HCC ... coding productivity and quality accuracy metrics set by the management team. May assist with Regulatory Audits by performing...+ 3 years of medical billing/coding, health insurance, and/or healthcare experience **Preferred** + 1 year of HCC risk… more
    Highmark Health (04/18/24)
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  • Intake Coordinator

    Highmark Health (Providence, RI)
    …the patient, and then creates the case (data entry) in Highmark's utilization management system for clinical review. Ensures all accurate information is entered at ... verification of benefit eligibility. Build cases in the utilization management system. + Use knowledge of process and judgement...0 - 1 year of experience working in the Healthcare Industry **Preferred** + 0 - 1 year of… more
    Highmark Health (04/10/24)
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  • Senior Revenue Integrity Analyst

    Highmark Health (Providence, RI)
    …are involved. Develops, implements and maintains Revenue Integrity and CDM Management policies, procedures and training materials. (20%) + Collaborates with ... Audit and other Revenue and Finance departments on revenue management initiatives. (10%) + Develops and maintains a Quality...as assigned. QUALIFICATIONS: Minimum + Bachelor's Degree in Business, Healthcare or related field OR six (6) of related… more
    Highmark Health (03/15/24)
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  • Senior Project Manager

    Highmark Health (Providence, RI)
    …and delivers of complex programs that require cross-functional collaboration and management of inter-dependencies between a group of projects and/or related ... activities within the constraint of scope, quality, time and budget. Includes the management of a group of internal exempt and/or matrixed employees and contractors… more
    Highmark Health (04/25/24)
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  • Senior Medical Stop Loss Underwriter

    Highmark Health (Providence, RI)
    …Analyzes associated policies, guidelines, market data to continuously improve risk management and gain appropriate enrollment or manage existing membership. Analyzes ... to account for these situations. + Apply corporate risk management policies and adjust for unusual situations that may...+ Actively pursuing a professional designation related to the healthcare industry and be willing to complete one course… more
    Highmark Health (04/12/24)
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  • Lead Architect - Cloud AI/ML/Software Solution…

    Highmark Health (Providence, RI)
    …new ideas and contribute to the advancement of AI and GenAI in the healthcare technology space. This role requires a professional dedicated to staying on top of ... that the system architecture balances functional, service quality and systems management requirements. + Use appropriate tools, including models of components and… more
    Highmark Health (05/14/24)
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  • Pharmacy Analyst

    Highmark Health (Providence, RI)
    …**Substitutions** + None **Preferred** + Bachelor's Degree **EXPERIENCE** **Required** + Healthcare experience + Project Management experience **Preferred** + ... location. Work with Pharmacy Markets business owners, stakeholders and other management , as required, to achieve Pharmacy Markets growth objectives. Organize and… more
    Highmark Health (05/03/24)
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