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Notifies appropriate insurance personnel to pre-certify surgeries or tests ordered by the physician or other health care provider, which require pre-certification by the insurance company.
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Responsible for selling payer credentialing and network management software solutions, and possibly additional HealthStream solutions, to health plan prospects with a specific focus on our existing hospital customer base with owned/operated health plans within their system.
Full-timeExpandApply NowActive JobUpdated 20 days ago - UpvoteDownvoteShare Job
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Works with staff and senior management to develop and implement provider contracting and service strategies to contain unit cost, improve member access and enhance provider satisfaction with the Plan. Also oversees provider credentialing, delegation oversight and provider network administration activities.
Starting at $186,201.39 - $363,092.71 a year depends on education, experienceFull-timeExpandApply NowActive JobUpdated Today - UpvoteDownvoteShare Job
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May participate in health plan credentialing operations and clinical aspects of the credentialing program and provider services support. Provides clinical expertise and coordinates between internal clinical programs and providers of care to improve the quality and cost of care delivered to health plan members.
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Negotiates contracts and terms in collaboration with CEO and CFO. Ensures organization meets HRSA and health plan provider credentialing requirements. The center offers primary health care services, adult medicine, pediatrics, family planning, OB/GYN, HIV and homeless services.
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Provider Relations Representative works as the primary liaison between Community First Health Plans and network participants (physicians, providers, and administrators) of the health plan provider network.
Full-timeExpandApply NowActive JobUpdated 4 days ago - UpvoteDownvoteShare Job
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Knowledge of the health insurance industry, state and federalregulations, provider reimbursement methods and evolving accountablecare and payment models. Medical Director would have a MD or DO degree, at least 5 years clinicalexperience, plus at least 2 years medical utilization management and/orcase management experience (prefer health insurance experience andadditional MHA or MBA training), or an equivalent combination ofeducation and experience.
ExpandApply NowActive JobUpdated 7 days ago - UpvoteDownvoteShare Job
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Three years' experience in a role that performs or supports provider credentialing, privileging, and/or enrollment in either a hospital, managed care plan or CMS environment is required.
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Understanding of medical plan credentialing and provider enrollment. The position also serves as a liaison between Health Plans, PBM’s, Pharmacy Operations, Third Party Accounting, Pharmacy Systems, Credentialing, Clinical Services, Compliance, and Legal.
$131,200 - $183,640Full-timeExpandApply NowActive JobUpdated Today - UpvoteDownvoteShare Job
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Ensures database accuracy so that Provider Enrollment can complete health plan enrollment. Maintains and protects the integrity of the credentialing database as the source of truth for privileged provider information throughout the health system's various IT systems such as the electronic health record, online provider directory, and billing system.
Full-timeExpandUpdated 13 days ago - UpvoteDownvoteShare Job
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Well versed in the use of the Cactus Database CPCS (Certified Provider Credentialing Specialist) In addition to the estimated base pay provided, Catholic Health offers generous benefits packages, generous tuition assistance, a defined benefit pension plan, and a culture that supports professional and educational growth.
$27 - $30 an hourFull-timeExpandApply NowActive JobUpdated Today - UpvoteDownvoteShare Job
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Chairperson/ Co-Chair of the HEDIS Improvement Committee, Quality Management Committee, Quality Improvement Committee, Credentialing Committee, Grievance Trend Committee k. Act as a liaison to Provider Relations as a link between IEHP and individual physician, IPAs, medical groups, and hospitals.
$240,676.8 a yearExpandApply NowActive JobUpdated 3 days ago - UpvoteDownvoteShare Job
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Essential Functions (CMA) Assists in the assessment of patient needs and health plan by taking vital signs, history, medication listing, assessing visual acuity and determining chief complaint.
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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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BENEFITS Our competitive benefits package includes the following Immediate eligibility for health and welfare benefits 401(k) savings plan with dollar-for-dollar match up to 5% Tuition Reimbursement PTO accrual beginning Day 1 Note: Benefits may vary based upon position type and/or levelQUALIFICATIONS EDUCATION - Bachelor's or 4 years of work experience above the minimum qualification EXPERIENCE - 1 Year of Experience.
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provider credentialing health plan jobs
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