Network Contract Manager I Requisition ID 2024 40174 Category Health Plan Service Operations Location Name Rev Hugh Cooper Admin Center Location City Albuquerque Location State/Province NM Minimum Offer USD $23.90/Hr. Maximum Offer for this position is up to USD $36.48/Hr. Overview Now hiring Network Contract Manager I The Provider Network Specialist is responsible for id

Under direction of both the Director and CDI Manager, the Clinical Documentation Specialist independently prioritizes and performs assigned duties and tasks. Clinical Documentation Specialists are responsible and accountable for the day to day management and success of the Continuous Documentation Improvement Project to include all modalities, acting as a liaison with spe

Data Enhancement Identifies and implements enhancements for the quality, management, and storage of Regulatory Reporting data. Executes initiatives that improve profiling, exception reporting, and issue resolution. Builds dashboards to modernize analytics where appropriate. Business Support Creates data policies and procedures to be used both within the department. Review

This position is responsible for the SDO process improvements in any of the following areas eligibility, enrollment & billing, claims administration and member/provider services across one or more lines of business. Partnering with operational process owners to establish strategic goals and process measures. Modifying, monitoring, continually improving, and standardizing

Opportunity awaits! Compass Group USA, the leading foodservice and support services company, is seeking an outstanding Associate Business Product Owner Sales Enablement (REMOTE) to join our world class team. In this role, you will be a key player in crafting the industry and implementing innovative solutions. With our daring growth plans, you will have the chance to creat

Location Wichita, KS (Onsite) Key Accountabilities Monitor Spirit for financial compliance with the U.S. Government rules and regulations Responsible for disseminating current policy and providing advice, ensuring effective EVM implementation on new contracts, analysis of contractor performance reports, facilitating Integrated Baseline Review (IBR), risk assessments, supp

Manage the evaluation of payer proposals related to Fee For Service (FFS), capitation arrangements and value based contracts Partner with the payer contracting team to manage the modeling and negotiation process, evaluate proposals, and provide guidance to senior leadership on the financial impact and viability of the contract Work closely with the Finance and Actuarial t

Responsible for Fraud Operations production responsibilities of case closure and the disputes case referral process including preparing and closing cases for potential Suspicious Activity Reporting (SAR). Additionally owns key functions to include but not limited to escheatment, charge off, check creation, office of the president complaints, FCRA complaints, IRS leads, CO

Under direction of both the Director and CDI Manager, the Clinical Documentation Specialist independently prioritizes and performs assigned duties and tasks. Clinical Documentation Specialists are responsible and accountable for the day to day management and success of the Continuous Documentation Improvement Project to include all modalities, acting as a liaison with spe

West Creek 3 (12073), United States of America, Richmond, Virginia Anti Money Laundering (AML) Fraud Investigator II The qualified candidate will support various Anti Money Laundering (AML) Fraud processes for our various lines of business, which might include suspicious activity investigations, reporting, enhanced due diligence, or other AML Fraud processes. Our ideal can

Under direction of both the Director and CDI Manager, the Clinical Documentation Specialist independently prioritizes and performs assigned duties and tasks. Clinical Documentation Specialists are responsible and accountable for the day to day management and success of the Continuous Documentation Improvement Project to include all modalities, acting as a liaison with spe

Zions Bancorporation is one of the nation's premier financial services companies operating as a collection of great banks under local brands and management teams in high growth western markets. Zions is regularly recognized by American Banker as one of the "Best Banks to Work For" and as having a top banking team in its list of "The Most Powerful Women in Banking." Our cu

The Claims Manager's primary responsibility is the administration of Sentara Healthcare's Automobile, Professional and General Liability (AL/PL/GL) program. This includes consulting about Incidents, setting up Events/Claims/Lawsuits in the Claims Management System, assigning and adjusting case Indemnity and Expense Reserves, negotiating settlements, assigning defense coun

Provider education and outreach regarding policies, processes, and ease of use of our provider self service portal, provider express Responsible for the delivery of external provider training and education programs either in person, virtually or through larger external provider events (MGMA, Provider Town Hall and Expos) Build and nurture trusted relationships with high t

Position Highlights Position Insurance Verification Rep I Location Niles, IL Full Time/Part Time Per Diem Hours Per Diem A Brief Overview Under the management of the Manager, Patient Access, the Pre Certification Representative I is responsible to determine insurance eligibility and, as appropriate benefits, pre authorization / pre certification and medical necessity requ