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The Coordinator I, Provider Credentials is also accountable for ensuring the pharmacy credentialing process meets Navitus’ policies, complies with URAC standards, and ensures that Navitus does not allow non-qualified pharmacies to participate and non-qualified prescribers to process claims.
Full-timeRemoteExpandApply NowActive JobUpdated 14 days ago - UpvoteDownvoteShare Job
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The Provider Operations Business Analyst will be responsible for performance monitoring, research, analysis, development, implementation and coordination of Provider Operation's initiatives and related projects to ensure the highest integrity of HMSA's Provider Network data, credentialing, directories, and related operational functions.
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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.
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This position will also coordinate with: Compliance & Quality staff on the re-credentialing process; with Provider Contracting staff for contracting issues or concerns; and will periodically assist the Claims staff with auditing and troubleshooting of provider data to ensure proper claims adjudication.
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Key responsibilities will include claims payment and remittance, network management, provider credentialing, data exchange and reporting and quality oversight. Work Schedule: Monday - Friday, 8:00 am - 5:00 pm PST The Provider Network Manager develops the provider network through contract negotiations, relationship development, and servicing.
Full-timeExpandApply NowActive JobUpdated 3 days ago - UpvoteDownvoteShare Job
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Manage provider network relationships through contract negotiations, network development to prevent network deficiencies, oversight of transportation provider onboarding, and ensure credentialing policies are followed and maintained.
$52,900 - $71,400 a yearFull-timeExpandApply NowActive JobUpdated 30 days ago - UpvoteDownvoteShare Job
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Current Certified Professional Medical Staff Management (CPMSM) and/orCertified Provider Credentialing Specialist (CPCS) with the National Association Medical Staff Services is preferred.
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Our facilities include a state-of-the-art Behavioral Health Center, Cancer Center, Chest Pain Center w/PCI-Resuscitation, Family Center, Heart & Vascular Center, Imaging Services, Neonatal Intensive Care Unit, Orthopedic/Spine Center, Physical Therapy Services, Rehabilitation Center, Stroke Center, Surgical Services, Surgical Weight Loss Center, Network-of-Care Affiliated Physician Practices, and much more.
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The Regulatory Affairs Associate will be responsible for handling Regulatory Affairs Department activities, including contracts, compliance, surveys, audits, investigations, provider network and relations, and other regulatory compliance matters.
$125,000 - $150,000 a yearFull-timeExpandApply NowActive JobUpdated 11 days ago - UpvoteDownvoteShare Job
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Certified Professional Medical Services Management (CPMSM) or Certified Provider Credentialing Specialist (CPCS) The fully integrated network is comprised of PIH Health Downey Hospital, PIH Health Good Samaritan Hospital, PIH Health Whittier Hospital, 37 outpatient medical office buildings, a multispecialty medical (physician) group, home healthcare services and hospice care, as well as heart, cancer, digestive health, orthopedics, women’s health, urgent care and emergency services.
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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.
$18 - $22 an hourExpandApply NowActive JobUpdated 3 days ago - UpvoteDownvoteShare Job
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Dignity Health-Yavapai Regional Medical Center (DH-YRMC), now part of CommonSpirit Health, is a not-for-profit integrated healthcare provider that offers a broad range of inpatient and outpatient services including network-wide opportunities to advance your career.
$26.51 - $38.44 an hourExpandApply NowActive JobUpdated 4 days ago - UpvoteDownvoteShare Job
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The Deputy Chief Operating Officer (DCOO) is a member of MetroPlusHealth’s Senior Management team and is vital in providing assistance with the oversight, management, and supervision of Operations, in a matrix organizational structure including: PMO, Process Improvement, Provider Network Operations, Call Center, Credentialing, Facilities, Enrollment & Membership, Vendor Management, Customer Success, and Claims.
$260,000 - $287,000 a yearFull-timeExpandApply NowActive JobUpdated 3 months ago - UpvoteDownvoteShare Job
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Knowledge of healthcare provider licensing, certification, credentialing and DEA compliance requirements and procedures. GENERAL SUMMARY: The BPN Credentialing Specialist is responsible for credentialing the Bryan Physician Network physicians and advanced practice providers, keeping their hospital and clinic privileges current, and maintaining current applications for managed care and commercial insurance contracts.
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PIH Health is a nonprofit, regional healthcare network that serves approximately 3 million residents in the Los Angeles County, Orange County and San Gabriel Valley region. Responsible for overseeing the vision and maintaining continuity in the planning, development, and implementation of standards applicable to Medical Staff members relating to credentialing, reappointment, peer review, and quality.
Full-timeExpandApply NowActive JobUpdated 9 days ago
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