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This role will work across the enterprise to partner with key functions, including Health Plan Operations (HPO), provider contracting, provider audit, and other key implementation stakeholders, and may support multiple health plan clients.
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In connection with this, all employees must comply with both the Health Insurance Portability Accountability Act of 1996 (HIPAA) as described in the Notice of Privacy Practices and Privacy Policies and Procedures as well as all data security guidelines established within the Company’s Handbook of Privacy Policies and Practices and Information Security Policy.
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Provide processing instruction to claims adjudicator(s) and review payment levels to arrive at final payment determination. Work with provider network to solve claim inquiries and escalates issues to next level of supervision as appropriate.
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Respond to and resolve help desk/received customer inquiries via written, telephonic and/or various platform-type communication systems in a timely and accurate manner in compliance with organizational KPI/SLAs; provide guidance regarding complex and/or escalated inquiries.
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Provides direction on corrective actions needed including but not limited to processed claims, using enrollment, benefit and historical claim processing information. Base pay is determined by a variety of factors including a candidate’s qualifications, experience, and expected contributions, as well as internal peer equity, market, and business considerations.
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The General Counsel will also provide guidance on all litigation matters affecting PPNorCal. Responsible for all duties as the HIPAA Privacy Officer and the Health Care Compliance Officer for the organization.
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Assist clients with meeting employee benefit-related compliance regulations (HIPAA, ERISA, ACA) Establish and manage timelines to complete tasks, monitor financials, and request health and welfare plan renewals in preparation for changes, final review, implementation, and enrollment.
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As a member of the Network Development leadership team, the Manager of Network Operations will participate in the successful implementation of provider data management tools at Texicare. Ensure compliance with regulatory guidelines, such as HIPAA, CMS, and state-specific regulations, regarding provider data management and privacy.
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Lead Network Support Representative. 5 years of experience in Revenue Cycle. This role provides new and existing customers with the best possible service related to help desk inquiries, service requests, billing inquiries and other customer requests.
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Equal Opportunity Employer Minorities/Women/Protected Veterans/Disabled/Sexual Orientation/Gender Identity ( If you would like to contact us regarding the accessibility of our website or need assistance completing the application process, please contact number below.
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To oversee study personnel, implementation, and quality assurance in support of clinical research studies conducted by the Principal Investigator, Dr. Stephen Freedland, and his associates in his urology and cancer research lab.
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Determines whether to return, deny or pay claims following organizational policies and procedures. For accommodation requests, please contact HR Services Online at HRServices@highmarkhealth.org. This job adheres to the ethical and legal standards and behavioral expectations as set forth in the code of business conduct and company policies.
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Works primarily out-of-the office selling products/services (sales employees) California Consumer Privacy Act Employees, Contractors, and Applicants Notice. Perform research on new markets to inform internal system database.
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Highmark Health and its affiliates take affirmative action to employ and advance in employment individuals without regard to race, color, age, religion, sex, national origin, sexual orientation/gender identity, protected veteran status or disability.
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Benefits Implementation specialist works directly with Implementation Specialists, Sales, Human Resources, and Account Management Teams to onboard new clients and deliver client renewals.
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