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Assignments in Managed Care require strong contract writing skills as well as a general understanding of health care claims. As a Managed Care Contract Consultant with Banner Plans & Networks, you will utilize your experience in contract negotiations and relationship building.
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Position Purpose: Financial Analyst for Managed Care is responsible for analyzing and modeling managed care and population health risk agreements on behalf of Sinai Chicago Managed Care Department and Progress Health, Sinai Chicago’s, Clinically Integrated Network (CIN.
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Strong analytical skills needed to compile and analyze data including: managed care denials/underpayment/ overpayment identification and resolution, contract modeling and evaluation, filing appeals as well as aiding in decision support reporting.
Full-timeExpandApply NowActive JobUpdated 2 days ago - UpvoteDownvoteShare Job
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Key Words: Billing, Claims, Reconcile, IHS, Indian Health Services, Tribal Liaison, Medicaid, MCO, Managed Care, Tribal, Value Added, Community, Tribal 638, Tribal Governments, TCBOs, HSD/MAD, Claims Examiner, Auditor, Claims Processor.
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In conjunction with the VP of Managed Care Contracting & Payor Relations/legal department, reviews and negotiates any new 340B contracts and renegotiation of existing transaction fees. Participates in the policy and procedure development, maintains internal and external relationships (wholesalers, Covered Entities, and third-party administrator [TPA] vendors) as needed, 340B rules/guidance surveillance, assist in 340B off site audits as necessary, contract management/implementation, reporting/analyzing, and program enhancement/ optimization projects including annual budgeting.
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Provides daily management for the MLTC Pharmacy Program of over $250,000,000, including oversight of and support for the operation of the Heritage Health Managed Care Organizations' pharmacy benefit.
Full-timeExpandApply NowActive JobUpdated 3 days ago - UpvoteDownvoteShare Job
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Bachelor's degree in Business, Finance or related field, plus 5-7 years of experience in the health care industry (at least 3 years in managed care contracting), or an equivalent combination of education and experience.
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As part of this effort, Serco would execute the PERM review contract which includes collection of state eligibility policies and medical records; eligibility reviews, medical reviews, and data processing reviews, of selected state Medicaid and CHIP fee-for-services (FFS) and managed care claims; and supporting state and national reporting of payment error rate and development of corrective actions based on findings.
ExpandApply NowActive JobUpdated 5 days ago - UpvoteDownvoteShare Job
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Specifically, DHCS, in collaboration with the Department of Managed Health Care (DMHC) and the California Department of Insurance (CDI), is establishing a statewide, multi-payer, school-linked fee schedule (CYBHI fee schedule) to reimburse school-linked providers for the provision of specified outpatient mental health and substance use disorder (SUD) services furnished to students 25 years of age or younger at a school site.
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The Director of Managed Care Analytics is responsible for supporting the Vice President Managed Care as well as the Managed Care Contracting team in contract modeling, strategic planning, budgeting, financial analysis, and evaluating potential acquisitions.
ExpandApply NowActive JobUpdated 10 days ago - UpvoteDownvoteShare Job
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The POM possesses a thorough knowledge of the managed care, primary care clinic, urgent care, senior care, and retail/community pharmacy environment as it relates to pharmacy information systems, reimbursement, regulatory, compliance, and contract management.
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Knowledge of how to interpret a managed care contract, Medicare and Medicaid and Workers Compensation claims is a must. We are looking for a motivated performer to join our Business Office team as a Collections Specialist, with an extensive knowledge of claims reimbursement and collection efforts for Managed Care, Medicare, Medicaid, Workers Comp, Commercial plans, etc.
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The Steward network includes multiple urgent care centers and skilled nursing facilities, substantial behavioral health services, over 7,900 beds under management, and approximately 2.2 million full risk covered lives through the company's managed care and health insurance services.
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Performs managed care contracting on behalf of the hospital, review and analyze contract performance and develop in conjunction with the CEO and CFO a managed care strategy.
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Research contract terms/interpretation and compile necessary supporting documentation for appeals, Terms & Conditions for Internet enabled Managed Care System (IMaCS) adjudication issues, and referral to refund unit on overpayments.
$25.7Full-timeExpandApply NowActive JobUpdated 4 days ago
managed care contract jobs
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