....
Learn more at:
Job Summary: The Senior Claims Manager will oversee and ensure the efficiency and accuracy of healthcare... ...while driving cross-functional collaboration.
~ In-depth knowledge of medical terminology, coding systems (CPT, ICD-10), and insurance...
Suggested
Work experience placement
Local area
...experience.
Learn more at:
Job Summary: The Sr. Manager of Provider Network leads and manages provider contracting and... ..., reports, analysis, addendums and letters of agreement.
Knowledge of provider reimbursement, Medicare reimbursement, coding and HEDIS...
Suggested
Contract work
Work experience placement
Local area
...patient experience.
Learn more at:
Job Summary: The Manager of Medicare Enrollment is responsible for managing the day-to-... ...Contractor (RPC), Wipro, MARx, etc. is preferred.
~ Knowledge of CMS, LEP and LIS
~ At least 3 years of healthcare management...
Suggested
For contractors
Local area
...more at:
Job Summary: The Risk Adjustment Submissions Manager is a core member of the Risk Adjustment team who specializes in... ...communicate in English, both verbally and in writing
~ In-depth knowledge of claim processing rules and related edits employed by CMS and...
Suggested
Work experience placement
Local area
...outcomes while controlling costs and enhancing the patient experience.
Learn more at:
Job Summary: The Database Marketing Manager (Marketing) will be responsible for leveraging the technical and marketing expertise to drive engagement and improve the healthcare...
Suggested
Local area
Remote job
...experience.
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Job Summary: The Project Manager at Prominence Health fulfills a role in managing and driving key... ...preferred.
Project Management certification preferred.
Knowledge of computer systems and experience using databases and demonstrated...
Suggested
Local area
...Under the direction of the CFO, this role will be responsible for managing all aspects of accounting processes including monthly journal... ...financial analysis/accounting required, and strong conceptual knowledge of GAAP and SSAP.
~ Knowledge of ERP systems (Lawson...
Suggested
Local area
Remote job
...more at:
Job Summary: The Pharmacy Benefit Operations Manager provides supervision of a team in charge of daily, tactical support... ...software tools
Claims Processing Platforms (extensive knowledge required)
Customer Relations Management (CRM) tools
Reporting...
Suggested
Local area
...outcomes while controlling costs and enhancing the patient experience.
Learn more at:
Job Summary: The Product Development Manager is at the forefront of guiding our product strategy by orchestrating collaboration with business leaders, technical teams,...
Suggested
Local area
...QA or PI experience preferred,
and a minimum two (2) years management experience.
Technical Skills: Computer proficiency to include... ...State of Nevada.
Other: Must be able to demonstrate the knowledge and skills necessary to provide service
appropriate to the...
Suggested
Local area
...preferred.
Experience: Three to five years food service management experience required.
Technical Skills: Computer skills:... ...days of employment.
Other: Must be able to demonstrate the knowledge and skills necessary to provide service
appropriate to the...
Suggested
Full time
Local area
Shift work
...Job Summary: This position is responsible for the day-to-day management of the Care Management (CM) program, D-SNP Care Management... ...will be considered.
Recent (within past 3 years) working knowledge of Milliman Care Guidelines, preferred.
Minimum of five years...
Suggested
Local area
...individualized discharge and providing proficient timely utilization management services to ensure that maximum reimbursement is achieved for... ...Management or Case Management preferred. Applicant must have knowledge of social and physical factors that affect functional status...
Suggested
Local area
...reports as required.
Develop employees through appropriate management practices, creates a hospital climate to motivate employees to... ...To be considered for this role, you must possess a working knowledge of GAAP, Medicare and Medicaid regulations, and federal and local...
Suggested
Local area
Relocation
...analysis and programming skills. The intern will then apply their knowledge and critical thinking skills to Analytics projects and provide... ...settings.
Must be able to work independently, providing management with status updates.
Self-starter, Resourceful and able to...
Suggested
Hourly pay
Internship
Local area
Shift work
2 days per week
...years prior experience in claims processing, computer operations, data analysis, data reporting, database management and creation of custom reports.
Advance knowledge of custom reporting tools and data base management program such as SQL, Microsoft Access and Impromptu....
Local area
...surgery, podiatry and sleep medicine. Independence Physician Management (IPM), a subsidiary of UHS, was formed in 2012 as the physician... ...graduate or equivalentFront office healthBasic computer knowledge.
Knowledge of medical clinic functions (scheduling, billing...
Full time
Part time
Local area
...Benefits
~3-5 years of experience with Medicare Advantage Health Plan
~ Knowledge of HMO, PPO, EPO, POS, Government Funded, Medicare and Medicaid plans
~ Knowledge of the Department of Managed Healthcare COB guidelines
~ Excellent customer service skills and...
Local area
...employees, the Application Support Analyst assumes some project management responsibilities for designated initiatives. This position... ...Experience working with a Healthcare Insurance company and knowledge of operational processes is preferred.
Good organization...
Local area
...adjudication processes, and collaborate with various stakeholders to maintain high-quality claims management practices. This role demands strong leadership skills, in-depth knowledge of healthcare billing and insurance procedures, and a commitment to delivering exceptional...
Local area
Flexible hours
...Learn more at:
Job Summary:
Under the direction of the Manager of Operations, the Appeals Specialist is responsible for ensuring... ...and willingly offers assistance.
Must demonstrate knowledge of those State and Federal laws and regulations, company policies...
Contract work
Work experience placement
Local area
...High school diploma or equivalent required. Associates degree preferred.
~1 to 3 years’ experience. Basic knowledge of Medicare regulations, experience in Managed Care Enrollment (MA, MAPD and PDP), Other Skills: Must possess previous experience processing Medicare...
For contractors
Local area
...of Sales this role is responsible for the acquisition and management of new fully insured and new ASO business with 51+ employee... ...servicing of health care and other employee benefit programs.
Knowledge of specific and aggregate stop loss, contract terminology for...
Contract work
Local area
...healthcare benefits programs.
~ At least 2 years of healthcare management experience including hiring, firing, employee coaching and... ...Processing Contractor (RPC), Wipro, MARx, etc. is preferred.
~ Knowledge of CMS, LEP and LIS
~ Knowledge of State and Federal...
For contractors
Local area
...Leadership. The incumbent will be relied upon to apply business knowledge to Analytics projects and provide value-added insights to... ...including revenue optimization, STARS/Quality, and medical cost management
~ Ability to effectively communicate in English, both verbally...
Work experience placement
Local area
Shift work
...Education: Four-year college degree in Human Resources Management, Business Administration or other applicable degree program. An... ....
License/Certification: None
Other: Demonstrated knowledge of federal and state laws as they apply to human resources management...
Work experience placement
Local area
...must provide most current competency check-off list from their school to their supervising manager and maintain current competencies. Must be able to demonstrate the knowledge and skills necessary to provide care/service appropriate to the department.
EEO Statement...
Apprenticeship
Local area
...The position will regularly interface with the pharmacy benefits manager, pharmacies, provider offices, and members. Specific day-to-day... ...software tools
Claims Processing Platforms (extensive knowledge required)
CRM tools
Reporting platforms (must be able to write...
Local area
...experience, insurance collections or healthcare experience with payers, managed care contracts and payer methodology or health care claims... ..., including customer service experience, preferred.
Working knowledge of CPT, ICD-10 and CDT coding and understanding of medical...
Local area
...promoting and maintaining quality patient care through effective management of the activities of total
patient care services during his... ...State of Nevada
Other: Must be able to demonstrate the knowledge and skills necessary to provide care/service
appropriate to...
Part time
Local area
Shift work