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2 years of progressively responsible experience in a business office or managed care credentialing setting with specific experience in provider enrollment. Follow up with necessary contacts, including providers and managed care plans, to resolve enrollment application issues.
Full-timeExpandUpdated 5 days ago - UpvoteDownvoteShare Job
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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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Technical Skills: Knowledge of managed care and/or TRICARE and the Military Health System (MHS) Collaborates with Utilization Management Director, TRIAD Directors, network providers, Military Treatment Facilities and TRICARE Regional Office West regarding TriWest’s RM program initiatives including submission, review, optimization and return of clinical documentation processes.
ExpandApply NowActive JobUpdated 2 days ago - UpvoteDownvoteShare Job
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Follows up on outstanding payments due on all types of open medical insurance claims, i.e., managed care and commercial. Ensures compliance with managed care guidelines and MMC organizational policies.
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Responsible for Product Sales Discounts and Rebate Tracking and Estimates for Managed Care Contracts, Part D Contracts, Co-Pay Card programs, Wholesaler Fees, Medicaid, FSS/PHS chargebacks, Tricare, Patient Discount Programs, Government / GPO chargebacks and Part D Donut Hole.
ExpandApply NowActive JobUpdated 8 days ago - UpvoteDownvoteShare Job
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Job SummaryServes as TriWests primary representative to the Military and Veterans Services Administration (VA) healthcare facilities within a specified geographic area relating to TriWest contracted services for the VA Community Care Network (CCN) and the Department of Defense (DoD) TRICARE West Region managed care support contract.
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Analyzes, compares and determines the financial impact of Medicare/Medicaid/ TriCare and commercial fee schedule changes and utilize the data to develop "what-if" scenarios to support managed care contract negotiations.
RemoteExpandApply NowActive JobUpdated 7 days ago - UpvoteDownvoteShare Job
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Working knowledge or familiarity with Managed Care, State and Federal health care programs (e.g. Medicaid, Medicare, TRICARE, VA Community Care Network), and the insurance industry; skill in diplomacy and negotiation; skill in financial analysis to analyze contractual reimbursement; skill in project management; skill in presentation; proficient with Excel.
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5 years of experience in a Managed Care or equivalent health care environment. Aligns with Network Subcontractors and Federal Stakeholders to identify areas of opportunity for deployment of alternative payment models to support TriWest's network and improve health care outcomes.
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Technical Skills: Working knowledge or familiarity with Managed Care, State and Federal health care programs (e.g. Medicaid, Medicare, TRICARE, VAPC3), and the insurance industry; skill in diplomacy and negotiation; skill in financial analysis to analyze contractual reimbursement; skill in project management; skill in presentation; proficient with Excel.
ExpandApply NowActive JobUpdated 7 days ago - UpvoteDownvoteShare Job
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As TriWest’s hybrid cloud and cybersecurity services partner, IBM is responsible for the delivery of the TRICARE Managed Care Support (MCS) T-5 contract. IBM’s scope is to provide hosting, platform engineering, infrastructure automation, managed operations, and security and compliance of the T-5 environments in Microsoft Azure for Government (MAG.
$81,000 - $151,000 a yearFull-timeExpandApply NowActive JobUpdated 8 days ago - UpvoteDownvoteShare Job
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Ensures compliance to managed care contract guidelines and processes at each work step to facilitate accurate and timely reimbursements to the organization. Ability to work within the guidelines of defined managed care contract policy provisions and company procedures.
ExpandApply NowActive JobUpdated 4 days ago - UpvoteDownvoteShare Job
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Maintains current knowledge of ICD diagnosis codes, CPT physician service codes, internal codes (for default services and for insufficient documentation), and governmental (Medicare, Medicaid, TriCare), commercial and managed care regulations by reading relevant professional literature and by attending workshops and lectures.
Full-timeExpandApply NowActive JobUpdated 18 days ago - UpvoteDownvoteShare Job
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Register TRICARE beneficiaries in the Composite Health Care System (CHCS) Experience in U.S. military healthcare delivery system or civilian managed care medical/administrative environmentExperience in a medical or clinical environmentExperience with the CHCS or civilian healthcare computer system and in processing medical claimsExperience in a public environment.
ExpandApply NowActive JobUpdated 14 days ago - UpvoteDownvoteShare Job
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At IBM, we pride ourselves on being an early adopter of artificial intelligence, quantum computing and blockchain. By the end of Phase 1A, the T-5 applications will have been deployed by TriWest and approved for production go-live to support Start of Healthcare Delivery (SHCD.
$81,000 - $151,000 a yearFull-timeExpandApply NowActive JobUpdated 27 days ago
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