Position Purpose:
Perform collaborative duties to assess, plan and coordinate continuum of care for select members at high risk for ED utilization in order to..
Position Purpose:
Assist in maintaining compliance with all regulatory laws and standards, including HIPAA; perform compliance reporting; and develop and..
Position Purpose:
Assist with the contract submission process and the auditing of provider information systems (AMISYS) for consistency and best practices in..
Position Purpose:
Perform collaborative duties to assess and coordinate member care. Forecast potential financial exposure throughout the continuum of care in..
Position Purpose: Investigate allegations of health care fraudulent activity. Assist in planning, organizing, and executing special claims investigations or..
Position Purpose:
Provides administrative and staff support to an organizational unit
Knowledge/Experience:
Requires a high school diploma with 4-7 years of..
Position Purpose:
Functioning in the capacity of the claims payment expert for the Plan and as a liaison between the plan, claims, Medical Management..
Position Purpose:
Assist the health plan in establishing a presence in the community; educate the members about the managed care services provided via the..
Position Purpose:
Receive and respond to member/customer inquiries via telephone and written correspondence in a timely and professional manner
Knowledge..
Position Purpose:
Perform day to day duties of assuring that providers (individual, group, ancillary, etc.) are set-up accurately in the provider information..
