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Experience working with managed care claims, third-party liability, Medicaid waiver programs, and provider enrollment; Knowledge and expertise in managed care claims, third-party liability, Medicaid waiver programs, and/or provider enrollment.
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Five (5) years of experience working with financial analysis supporting managed care contracting with providers including but not limited to hospitals, professionals ranging from large medical groups to solo practitioners, mental health practitioners, ASCs, skill nursing facilities, renal dialysis facilities, home health and DME. Current working knowledge of all aspects of a provider contract.
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Managed care, value-baed payment model, quality and population health management experience. MetroPlus Health provides the highest quality healthcare services to residents of Bronx, Brooklyn, Manhattan, Queens and Staten Island through a comprehensive list of products, including, but not limited to, New York State Medicaid Managed Care, Medicare, Child Health Plus, Exchange, Partnership in Care, MetroPlus Gold, Essential Plan, etc.
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A strong working knowledge of military health care system including TRICARE health benefits, fee –for service principles, preferred provider network and managed care/HMO organizations is highly desirable.
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8+ years of experience negotiating and drafting commercial agreements (including partnership agreements, managed care service agreements, participating provider agreements, program incentive agreements, provider network agreements revenue/sales contracts, and vendor agreements in the healthcare space.
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Health care regulatory knowledge focusing on Fraud, Waste, and Abuse; knowledge of Value-based care, Medicare Advantage Organizations, ACO REACH and MSSP programs is required. This role will provide regulatory guidance on various healthcare-related issues with a focus on Anti-kickback Statute (and related state statutes), Stark Law, Civil Monetary Penalties Law, and develop compliant solutions to to facilitate and promote One Medical's business objectives, including value-based care, care coordination, and health system affiliations.
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About KindbodyKindbody is a leading fertility clinic network and family-building benefits provider for employers offering comprehensive virtual and in-person care. As the fertility benefits provider, technology platform, and direct provider of high-quality care, Kindbody delivers a seamless, integrated experience with superior health outcomes at lower cost, making fertility care more affordable and accessible for all.
$29 - $32 an hourFull-timeExpandApply NowActive JobUpdated Today - UpvoteDownvoteShare Job
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Managed care contracting, provider relations or data analytics experience. 4 years of experience in the health care field interacting with members, physicians, medical groups or health plans, overseeing administrative updates, data analytics or provider relations activities required.
$70,000 - $114,268 a yearExpandApply NowActive JobUpdated 1 month ago - UpvoteDownvoteShare Job
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Kindbody's clinically-managed program covers the full-spectrum of reproductive health, including both female and male fertility, which encompasses fertility assessments and education, fertility preservation, genetic testing, in vitro fertilization (IVF), donor and surrogacy services, and adoption, as well as a full continuum of reproductive care including physical, mental, and emotional support.
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Collaborate with other organizational departments responsible for functional aspects of the HIV Special Needs Plan, including, but not limited to Integrated Care Management, Behavioral Health, Managed Long-Term Care, Utilization Management, Quality Management, Credentialing, Regulatory Affairs, Compliance, Corporate Affairs, Provider Network Operations, Medicare Services, Information Systems, Finance, Claims, and Member Services and Eligibility.
$150,000 - $157,236 a yearFull-timeExpandApply NowActive JobUpdated 3 months ago - UpvoteDownvoteShare Job
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Partner with COL, credentialing coordinators and other key stake holders in onboarding and enrollment providers and facilities with Medicaid, Medicare, commercial and managed care plans.
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Conducts intensive screening of all worker's compensation, Medicare, Medicaid and managed care patients for pre-certification requirements and provider service eligibility, prior to registration as applicable.
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Founded in 2013, Innovista Health offers solutions for providers at every point along the continuum of value-based care, ranging from care management, provider/ACO enablement, and quality improvement to performance insights, reporting, and managed administrative/payment services.
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Communicate and collaborate with all Tempus commercial positions including VP Sales, Sales Leadership, Clinical Account Executives, Precision Medicine Partner Directors, Account Associates and Managed Markets teams.
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Advise on managed care claims, third-party liability, Medicaid waiver programs, and provider enrollment. Extensive knowledge and practical experience in managed care claims, third-party liability, Medicaid waiver programs, and provider enrollment.
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