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Nationwide Blue Cross Blue Shield PPO with employee friendly plan design, including $850 individual annual medical deductible, $25 office visit copays, Low biweekly premiums.
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Has obtained or is eligible to obtain provider numbers from insurance carriers that currently contract nurse practitioners (Medicare, Medicaid, Blue Cross/Blue Shield etc.
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HCSC is the largest customer-owned health insurer in the United States, operating through its Blue Cross and Blue Shield plans in Illinois, Montana, New Mexico, Oklahoma, and Texas.
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Anthem Blue Cross and Blue Shield is a proud member of the Elevance Health family of companies offering Medicare plans, Medicaid, individual and family plans, and group insurance plans in Colorado, Connecticut, Georgia, Indiana, Kentucky, Maine, Missouri, Nevada, New Hampshire, Ohio, Virginia and Wisconsin.
Full-timeExpandApply NowActive JobUpdated 11 days ago - UpvoteDownvoteShare Job
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Choice of Blue Cross Blue Shield Medical, Dental and Vision Plans. Oversees vendor delivery to our Medicare Advantage and Exchange customers, including contract management, strategy development, operational delivery and invoicing.
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Position Summary: Responsible for preparing insurance billings pertaining to patient accounts; coordinates activities with all primaries, including RMSCO, Blue Cross/Blue Shield, Commercial, Compensation/No Fault, Medicaid and Medicare and all other insurance plan, and follow up with insurance companies to ensure timely payment.
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CareFirst of Maryland, Inc., Group Hospitalization and Medical Services, Inc., CareFirst Advantage, Inc., CareFirst Advantage PPO, Inc., CareFirst Advantage DSNP, Inc., CareFirst Community Partners, Inc., CareFirst BlueCross BlueShield Community Health Plan District of Columbia, CareFirst BlueChoice, Inc., First Care, Inc., and The Dental Network, Inc. are independent licensees of the Blue Cross and Blue Shield Association.
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We partner with community leaders and organizations to make healthy living resources available to all Mississippians through the work of the Blue Cross & Blue Shield of Mississippi Foundation, our support of the arts and culture and our Team Blue volunteers.
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Engages with external resources, including the consultant community, in order to evaluate and understand the current and emerging market for Medicare Advantage and Exchange programs. This role will have oversight responsibility for Medicare Advantage and ACA Exchanges strategy and executive relationship responsibility for our customers’ compliance executives.
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Other data sources are market research consultants, AMA, St. Anthony, Relative Value Studies for Dentists, Dun and Bradstreet and HIAA, CMS, Blue Cross and Blue Shield Association, Blue Cross and Blue Shield Plans, CMS, DHS, sales and marketing regional offices.
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OPM, Federal Register, CMS Bulletins, Blue Web Legislative report, etc.) Experience with Medicare Advantage and ACA Exchanges. CHC, CIPM or CIPP Privacy certification, preferred. Collaborates with BCBSM Compliance Office as necessary.
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Remain free from exclusion under the OIG and SAMS Medicare/Medicaid lists. The Prior Authorization Pharmacist provides educational and consultant services in the field of pharmacology and drug therapy medical professionals.
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Rx, dental, vision, short-term disability, and FSA. Review prior authorization requests using predetermined criteria and other medication resources. Perform retrospective drug utilization review: identify drug, physician and patient utilization trends; make interventions as appropriate via letters, phone calls, meetings, educational programs, mail order intervention programs; monitor and document outcomes as needed.
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Nationwide Blue Cross Blue Shield PPO with employee-friendly plan design, including a $850 individual annual medical deductible and $25 office visit copays, with low biweekly premiums.
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A company of 1,000 diverse people and almost 100 years of pharmacy experience, we offer the stability of a Fortune 500 company with the energy and innovation of a startup. One to two years experience in the managed care and pharmacy benefit management (PBM) industries preferred.
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