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EEO is The LawEqual Opportunity Employer Minorities/Women/Protected Veterans/Disabled/Sexual Orientation/Gender Identity ()We endeavor to make this site accessible to any and all users. Highmark Health and its affiliates take affirmative action to employ and advance in employment individuals without regard to race, color, age, religion, sex, national origin, sexual orientation/gender identity, protected veteran status or disability.
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Comply with relevant compliance regulations with the New York Department of Health (DOH), Department of Financial Services (DFS), and the Centers for Medicare & Medicaid Services (CMS). Responsible for tracking and reporting outreach efforts (in accordance with Company policies as well as DOH, DFS, and CMS guidelines.
Starting at $21.15 an hourFull-timeExpandApply NowActive JobUpdated 4 days ago - UpvoteDownvoteShare Job
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The incumbent applies actuarial techniques and statistical analysis to several functions, including insurance premium and pricing development, claim trend analysis, experience studies, medical economics, profitability analysis, wellness studies, predictive modeling, or claim reserving.
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Document vendor compliance with key contract terms / requirements. Description : JOB SUMMARYThis job is responsible to manage business functions / processes such as coordinating client invoicing, pricing health promotion products and services, acting as a subject manner expert in responding to complex client RFPs, identifying opportunities and implementing solutions to improve efficiency or reduce cost, and other projects that may be assigned.
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Provide after hours and weekend support as required for on call responsibilities, database refreshes, testing, technology upgrades, and other off hour assignments. Take a lead role to provide support for application staff and business areas regarding more complex database implementations, which could include a customized in-house database and/or a third party application package.
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Equal Opportunity Employer Minorities/Women/Protected Veterans/Disabled/Sexual Orientation/Gender Identity ( ) Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities, and prohibit discrimination against all individuals based on their race, color, age, religion, sex, national origin, sexual orientation/gender identity or any other category protected by applicable federal, state or local law.
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Description : JOB SUMMARYThis position is for an IT Infrastructure architect to drive our strategy, architectural designs, and implementations related to (1.) In connection with this, all employees must comply with both the Health Insurance Portability Accountability Act of 1996 (HIPAA) as described in the Notice of Privacy Practices and Privacy Policies and Procedures as well as all data security guidelines established within the Company’s Handbook of Privacy Policies and Practices and Information Security Policy.
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3) develop technical content (competitive intelligence, market trend analysis); 4) support development of formal recommendations to Senior Levels leadership; 5) help create document components (go-to-market or operational strategies, etc.
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Ensure accuracy of data entry to prevent compliance and/or downstream process issues. Description : JOB SUMMARYThis job captures all inbound requests for utilization review from providers and pharmacies.
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Utilize PC and/or mainframe based systems and software, compile and prepare reports, graphs and charts of data developed. Please note this will be a hybrid role and will require candidates to work in our Pittsburg office ESSENTIAL RESPONSIBILITIESCommunicate effectively.
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Work with Executive Sponsor and Business Owner of a Program, and other management as required, to achieve the Program objectives. Direct corrective action, as needed, to maintain the viability of the Program.
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Description : GENERAL OVERVIEW:Completes one or more of the following processes (scheduling, pre-registration, financial clearance, authorization and referral validation and pre-serviceability estimations and collections) within Patient Access and creates the first impression of AHN's services to patients and families and other external customers.
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