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Description The Medical Coding Auditor extracts clinical information from a variety of medical records and assigns appropriate procedural terminology and medical codes (e.g. CPT) to patient records. The Medical Coding Auditor ..
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Job Information Humana Provider Contracting Professional in Pittsburgh Pennsylvania Description The Provider Contracting Professional 2 Behavioral Health Network role; initiates, negotiates, and executes physician, hospital, and/or other provider contracts and agreements ..
Description The Payment Integrity Professional 2 uses technology and data mining, detects anomalies in data to identify and collect overpayment of claims. Contributes to the investigations of fraud waste and our ..
Description The Staff Clinical Pharmacist manages the formulary processes for the Clinical Formulary Administration team for the Medicaid LOB. The Staff Clinical Pharmacist work assignments involve moderately complex to complex issues ..
Description The Associate Actuary, SPA RX will be mainly responsible for supporting the pricing work related to our standalone Prescription Drug Plans (PDPs). This includes both bid development and reforecasts throughout ..
Description Responsibilities The Business Support Coordinator 1 performs medical record content analysis to ensure compliance with requirements of the TRICARE contract. Prepare, scan, and stage for final distribution all medical records ..
Description The Associate Actuary, Analytics/Forecasting analyzes and forecasts ... operational decisions within Care Delivery Finance. Evaluates industry, economic, financial, and ... financial and competitive position. The Associate Actuary, Analytics/Forecasting work..
Description The Provider Contracting Professional 2 initiates, negotiates, and executes dental provider contracts and agreements for an organization that provides health insurance. The Provider Contracting Professional 2 work assignments are varied ..
Description The Senior Value-Based Programs Analyst supports successful value-based provider relationships with a focus on improving the provider experience and achieving path-to-value goals. The Senior Value-Based Programs Analyst works on problems ..
Description Responsibilities The Autism Care Demonstration (ACD) Senior Learning Design Professional analyzes content, organizes content, designs solutions, and writes storyboards, scripts, performance support, newsletters and notification letters. Analyzes learning needs and ..
... physicians, physician groups, and integrated healthcare delivery systems throughout the country. ... delivery systems throughout the country. Healthcare isn't just about health anymore. ... of our members, and the..
Description The Care Manager, Telephonic Nurse 2 , in a telephonic environment, assesses and evaluates members' needs and requirements to achieve and/or maintain optimal wellness state by guiding members/families toward and ..
Description The Senior Provider Engagement, Clinical Professional develops and grows positive, long-term relationships with physicians, providers and healthcare systems in order to support and improve financial and quality performance within the ..
... that our members receive quality healthcare at an affordable price. You ... (RN) license 3 years of healthcare experience within a fraud investigations ... well as solid knowledge of..
Description The Senior Value-Based Financial Analyst supports successful value-based provider relationships with a focus on improving the provider experience and achieving path-to-value goals. The Senior Value-Based Programs Professional works on problems ..
... large accounts and/or provider relations Associate management oversight of 3-5 direct ... and network administration in a healthcare company or healthcare system Medicaid behavioral health contracting ... in the..
Job Information Humana Actuary, Risk and Compliance in Pittsburgh Pennsylvania Description This Actuary role is a newly created role within the Senior Products Actuarial Compliance team focused on special Medicare Advantage ..
... roadmaps. Working closely with the Associate Vice President of Pharmacy Product ... insights Bachelor's degree in Business, Healthcare Administration or other related fields ... 50 market leader in integrated..
Description The Pharmaceutical Manufacturer Relations Executive ensures the Pharmacy trade strategy aligns with formularies and the desired health outcomes of patients. The Pharmaceutical Manufacturer Relations Executive works on problems of diverse ..
Description The Large Group Medical Underwriter computes rates for both renewing and prospective moderate to complex group accounts. The Large Group Underwriter 2 work assignments are varied and frequently require interpretation ..
Description The Financial Analytics Professional 2 manages data to support and influence decisions on day-to-day operations, strategic planning and specific business performance issues. The Financial Analytics Professional 2 work assignments are ..
Description The Hospital Contracting Executive initiates, negotiates, and executes physician, hospital, and/or other provider contracts and agreements for an organization that provides health insurance. The Hospital Contracting Executive works on problems ..
