Manager, Post-Service Claims & Clinical Policy Analytics
100 Horizon Healthcare Services, Inc
100 Horizon Healthcare Services, Inc in Newark, New Jersey, is seeking a qualified candidate responsible for the design and implementation of Medical Policy. The role encompasses managing operational functions within Clinical Coding and Reimbursement. The ideal candidate should possess extensive experience in healthcare management and regulatory compliance, with a preference for candidates holding a Bachelor’s degree in Nursing or a related field. A comprehensive benefits package including health benefits, retirement plans, and training reimbursement is offered. #J-18808-Ljbffr
$123k - $167.9k
Horizon Blue Cross Blue Shield of New Jersey is seeking a Director of Clinical Operations to lead initiatives in healthcare management and clinical coding. This role requires a strong background in healthcare operations, project management, and regulatory compliance. Candidates...PolicyClaims$123k - $167.9k
...of Plan Medical and Reimbursement Policy, Clinical Coding, Post-service Claims Reviews and Appeals, development,... ...and application of all Departmental Analytic Tools, and oversight of Special... ...Editing, Communications, Pharmacy Management, Legal, Quality Management, and Payment...PolicyClaims- ...your role as Senior Site Manager, you will oversee... ...roleUse weekly customer service metric reporting to deliver... ..., accidents, or claims with corporate team.Always... ...Maintain updated site policy and procedure manuals.... ....Established analytical, problem-solving, and...PolicyClaimsFull timeTemporary workLocal areaFlexible hoursAfternoon shift
$106k - $145.75k
...empathy, insight, and clinical intelligence, we... ..., and our Privacy Policy: applies to any... ...Job Description Post-Market Clinical Affairs... ...evaluations, risk management files, and... ...PowerPoint) with strong analytical skills. Work... ...schemes that falsely claim to represent Solventum...PolicyClaimsH1bWork at officeRemote workRelocation packageFlexible hours- ...specialty health management that focuses on progressive... ...Solutions uses clinical big data... ...and high-powered analytics to power complex... ...of experience in claims or gap closure campaigns... ...in healthcare services, clinical... ...with organization policies for health screening...PolicyClaimsWork at office
- ...Job Title: Data & Analytics / Enterprise Architecture Location... ...master data domains including Policy, Customer/Party, Agent,... ...administration systems, and claims management systems. Data Governance... ...patterns using REST APIs, Azure Service Bus, Event Hub, and ETL/ELT...PolicyClaims
$115.02k - $207.22k
...Manager of DRG Coding & Clinical Validation Audit Manager of DRG Coding... ...of the designated posting location(s): Virginia... ...Please note that per our policy on hybrid/virtual... ...and recoverable claim opportunities, and supporting... ..., and data analytics teams to align audit...PolicyClaimsWork at officeLocal areaShift work3 days per week- ...Job Overview: The Product Manager leads the planning, development... ...the expansion of our product analytics and insights across a wide... ...marketing and/or healthcare claims data ~Minimum of a Bachelor... ...strict design principles and policies ~Ability to translate ideas...PolicyClaimsFull timePart timeFlexible hours
$57.06k - $62.77k
Overview Operations Support Services - Team Lead Primary... ...monitor resolution. Manage staffing schedules to... ...Administer company personnel policies, follow staffing... ...two (2) years claims management experience.... ...motivational skills. Excellent analytical and interpretive...PolicyClaimsWork at office$96k - $132k
Job Description Clinical Development Analyst (Solventum) Company... ...in Health Information Management. - Certified Coding Specialist... ...accordance with its travel policy. This applies to new hires... ...remain alert to fraudulent job postings that claim to represent Solventum and...PolicyClaimsH1bRemote workWorldwideRelocation packageFlexible hours- ...Manager of Clinical Services (RN) - Dialysis/Nephrology Essex County, NJ You became a nurse to make a difference. After years at the... ...practical, digestible guidance for adult learners Support policy development and champion best practices across your region...PolicyRemote workShift workRotating shiftWeekday work
$57.06k - $62.77k
Operations Support Services - Team Lead... ...through resolution. Manages staffing schedules... ...company personnel policies in all areas and follows... ...two (2) years claims management experience... ...skills Excellent analytical and interpretive... ...transparency in job postings. Actual...PolicyClaimsWork at officeLocal areaFlexible hours$125.1k - $151.1k
...segment. The Account Manager for the Labor... ...Horizon teams to ensure service delivery,... ...internally with Service, Claims, Provider... ...rating processes and policy renewal practices.... ...g., wellness, IT, clinical). Strong collaboration... ...Horizon at the time of posting. Compensation...PolicyClaimsContract workLive inLocal area- ...Title: Senior Account Manager - Commercial Lines... ...this position is posted as either fully... ...accordance with company policy, individuals... ...administrative and customer service activities,... ..., billing, claims, and coverage analysis... ...~ Strong analytical, problem-solving,...PolicyClaimsRemote work
$171k - $249k
...a global product-specific analytics strategy Scope out potential... ...project Project management and prioritization of all analytics... ...of insurance, including policy, coverage, claims, and regulation. Property... ...its extensive product and service offerings, broad...PolicyClaimsFull timeTemporary workLocal area- ...solutions that help you manage your talent and... ...Description: **Strong customer service and claims processing background... ...system for clinical review. Initiates call... ...professional medical/claim policy related issues or... ...Team Player, Strong Analytical, Interpersonal Skills...PolicyClaimsWork experience placement
$56.8k - $71k
...The Account Manager position is one of the... ...availability, promotes services, defines process... ...letters. Prepares claims experience reports... ...priorities for analytical work in order to meet... ...industry policies and contract documents... ...may vary from the posted range due to individual...PolicyClaimsContract workTemporary workWork at officeLocal areaRemote work- ...Managed Care Coordinator Integrated Resources... ...on excellent service and integrity since... ...Technology (IT), Clinical Research, Rehabilitation... ...knowledge of claims processing required... ...medical/claim policy related issues or... ...Team Player, Strong Analytical, Interpersonal Skills...PolicyClaimsWork experience placement
$18 - $29.76 per hour
...DOE) The Patient Service Representative (... ...executing revenue cycle claim scrubbing and... ...while adhering to policies and procedures... ...flow through the clinical care process. •... ...critical thinking, analytical, troubleshooting,... ...Mathematical and cash management skills. •...PolicyClaimsWork at office$55k - $62k
Benefits Account Manager In Public Entity A... ...cybersecurity, mortgage services and more. In the... ...requests Provide policy interpretation and... .... Ensure all post renewal activities... ...resolving eligibility or claims issues, to ensure... ...interpersonal, analytical, and written communication...PolicyClaimsImmediate startFlexible hours- ...Description AbbVie’s Analytics and Performance Excellence... ...on market access and policy disruptors. The... ...Market Access and Patient Services (MAPS) Team within APEX... ...("Follow the Dollar", claims analysis, and scenario... ...role at the time of this posting based on the job grade...PolicyClaimsTemporary work
$151.04k - $198.2k
...label. Works with office management to provide various... ...in territory. Deliver clinical, efficacy, and safety... ...Kickback Statute; False Claims Act, OIG/DOJ Guidance;... ...Experience in business analytics to understand and... ...such, is committed in policy and in practice to recruit...PolicyClaimsWork at officeLocal area- ...IVI RMA North America is looking for a Clinical Services Supervisor with overseeing offices in... ...office’s metrics and collaborates with management to discuss any staffing concerns.... ...on all clinical standard of practice policies and work instructions. Effectively communicates...PolicyFull timeWork experience placementWork at officeMonday to FridayFlexible hours
$241k - $332k
...seeking a Sr. Vice President, Claims Finance, Analytics & Operations. This is a... ...leadership, Actuarial, Risk Management, Advanced Analytics, and other... ..., including customer service, employee work environment,... ...Ensures adherence to companywide policies, including procurement...PolicyClaimsInterim roleWork at office- ...workforce solutions that help you manage your talent and business more... ...to marketplace trends, claim procedures, and health industry... ...prospects on client products and services. · Performs other duties as assigned... ...knowledge of rating and policy renewal practices. · Prefers knowledge...PolicyClaimsContract work
- ...telecommute role to review health claims, ensuring compliance with policies and guidelines. This position offers... ...medical files for appropriateness of services and participating in quality... ...board certification and a current unrestricted clinical license. #J-18808-Ljbffr...PolicyClaimsRemote work
$110k - $130k
Description Our Manager of Case... ...case management clinical team and non-clinical... ...quality service delivery and manages... ...vary within the posted range based on... ...and departmental policies, procedures,... ...manner. ~ Strong analytical, problem-... ...businesses. We process claims and provide...PolicyClaimsFor contractorsWork at officeLocal areaImmediate startRemote work2 days per week- ...Legal and Compliance Manager. The ideal candidate will... ...and in-house policies. You will be tasked with... ...including sales, procurement, service agreements, and HR... ...Handle legal disputes and claims. Manage trademark... ...experience 7. An analytical mind able to "see" the...PolicyClaimsContract workLocal areaFlexible hours
- ...next‑generation data and analytic solutions that help us... ...medical and pharmacy claims data to inform... ...the firm’s data risk policies, refining and operationalizing... ...multiple functional service lines spanning Commercial... ...data, EMR data, clinical trials data, commercial...PolicyClaimsApprenticeshipEasy work
$182k - $346k
...AbbVie Clinical Development Role AbbVie's... ...and products and services in our Allergan Aesthetics... ...: Manages the design and implementation... ...per corporate policy and regulations... ...the time of this posting based on the job grade... ...or communication claiming to be from AbbVie,...PolicyClaimsWork at officeImmediate startRemote workMonday to Friday
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