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Experience in Facets, or similar provider data or claims processing system. " Experience in other provider related healthcare departments such as credentialing, provider relations or contracting preferred.
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Knowledge of two or more MMIS business operational areas such as Claims Processing, Authorized Services, Customer Centers, Mailroom, Pharmacy, Provider Enrollment, or Provider Relations SURS is also preferred.
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Knowledge of Federal and State law, NCQA, Medicare, Medicaid, and relevant guidelines, regulations and standards; i.e., claims processing, UM programs, provider contract administration.
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Maintains a working knowledge of all company managed care activities: Provider Contracting, Member Services, Utilization Management, Claims, Capitation, Enrollment Provider Relations, Finance, etc., to provide RPA, payment integrity and Facets Configuration solutions for the enterprise.
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Establishing and maintaining processes that require collaboration with various enterprise groups, such as Provider Relations; Fraud, Waste, and Abuse; Accounting; Finance; and more. In support of the launch of the claims processing capabilities, Evernorth Accountable Care is seeking an experienced Claim Operations senior leader to build a high performing team of claim analysts and operations personnel to support the business in ongoing claim operations.
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Participate in standing meetings as necessary, including but not limited to, provider relations, contracting, network development and team building. Minimum of 2-3 years of experience in a managed care claims processing environment required, including the processing of all medical claim types and the handling of complicated claims issues.
$33.46 - $50.2 an hourFull-timeRemoteExpandApply NowActive JobUpdated Yesterday - UpvoteDownvoteShare Job
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Sante Health System provides numerous client services such as billing, claims processing, contracting, credentialing, finance, human resources, information services, marketing/communications, physician services, practice management, provider relations, quality improvement, and utilization management.
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Provider Relations: Collaborate with the network providers and with the Sendero Network Team to resolve claims related inquiries, disputes, and grievances, fostering position relationships, and promoting efficient communication channels.
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The individual(s) in this position are responsible for provider relations and is the face of Navitus to our pharmacy providers. Responsible for all aspects of maintenance related to pharmacy network functions, such as, network plan design builds, quality assurance measures and claims processing in general.
$47,309 - $60,263 a yearRemoteExpandApply NowActive JobUpdated Today - UpvoteDownvoteShare Job
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5+ years of sales, provider relations, or contracting experience. Claims processing and/or managed care experience preferred. For Fidelis Care only: Must have valid driver license, personal vehicle and ability to travel.
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Responsible for the PHC Claims System Provider Check Status Update. Research, maintain a log, and coordinate with Provider Relations for proper resolution. work closely with Claims Recovery Unit on the accounting of provider refunds.
$65,516.97 - $85,170.87 a yearFull-timeExpandApply NowActive JobUpdated Today - UpvoteDownvoteShare Job
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The Pharmacy Relations Specialist (PRS II) is a highly motivated professional with at least 2 years of successful experience working in a pharmacy or interfacing directly with pharmacies or accounts, preferably in healthcare.
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Reporting to the Senior Vice President, Enterprise Operations, the Vice President, Claim Payment Administration is accountable for partnering with organizational leadership to provide direction for application programming of the enterprise claims and provider platform, process improvement through robotic automation and preventing, detecting, investigating, and reporting fraud, waste and abuse (FWA.
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Examples: processing checks, transfers, film breakdowns, and ordering of films) Research and forward case settled/cancel Emails received from client relations to the appropriate employee and department in a timely manner.
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5+ years of combined management and provider data management, credentialing or healthcare operations (i.e. claims processing, billing, provider relations or contracting) experience, preferably in a managed care or insurance environment.
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claims processing provider relations jobs
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