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Leading the Contracting & Provider Relations functions for the Southern Bureau health plans and Provider Data Management function for the Managed Care Division. The Director of Contracting and Provider Relations is responsible for projecting and integrating the Mission and Core Values of the organization within and outside of the Public Health Department.
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Centene offers a comprehensive benefits package including: competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules.
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Educates providers and supports provider practice sites regarding the National Committee for Quality Assurance (NCQA) HEDIS measures and risk adjustment. Collaborates with Provider Relations and other provider facing teams to improve provider performance in areas of Quality, Risk Adjustment and Operations (claims and encounters.
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Delivers, advises and educates provider practices and IPAs in appropriate HEDIS measures, medical record documentation guidelines and HEDIS ICD-9/10 CPT coding in accordance with state, federal, and NCQA requirements.
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License/Certification: One of the following required: CCS, LPN, LCSW, LMHC, LMSW, LMFT, LVN, RN, APRN, HCQM, CHP, CPHQ, CPC, CBCS. Pay Range: $25.97 - $46.68 per hour Centene offers a comprehensive benefits package including: competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules.
$25.97 - $46.68 an hourFull-timeExpandApply NowActive JobUpdated Today - UpvoteDownvoteShare Job
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Will work with Provider Contracting, Credentialing, Claims Operations, Utilization Management, and Network Management to setup systems to ensure accuracy of payments processing. Work with provider reimbursement tools, collaborate with Claims Operations, Utilization Management, and Network Management to setup pricing methodologies.
$160,000 - $170,000Full-timeExpandApply NowActive JobUpdated 4 days ago - UpvoteDownvoteShare Job
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The Provider Relations Representative will provide training, education and guidance while building a strong relationship with our provider partners by in-person or virtual visits, and phone calls.
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Serves as the Tenet leads with Tenet National Director Clinical Denials, Sr. Director Revenue Cycle, hospital CFOs, Directors Revenue Analysis (DRAs), and Managed Care Contracting to design concurrent processes to secure authorizations and prevent clinical denials.
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Is a family owned and operated heavy civil construction services and site contracting company based in Perkasie, Pennsylvania. Class A CDL with 1 year of commercial driving experience OR Class B CDL with 1 year of triaxle driving experience.
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General Description: Reporting to the SVP, Managed Care, the Director, Managed Care Analytics oversees payer reimbursement modeling and data analytic support to OU Health Managed Care Contracting functions, and transforms claims and clinical data into actionable reports, designs and performs contract modeling and develops contract performance dashboards.
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Continuing education and tuition reimbursement. This is an orthopedic based office treating a variety of orthopedic cases including sports medicine, hand therapy, dry needling, musculoskeletal disorders, osteoporosis, work injury rehab and more.
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The Director, MA & Medicaid Contracting on the Strategic Payer Partnerships team will execute Aledade's Medicare Advantage and Medicaid value-based care contracts with national and regional health plans as we help primary care providers shift into value-based care.
$150RemoteExpandApply NowActive JobUpdated Today - UpvoteDownvoteShare Job
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The ideal candidate will have extensive business leadership experience, with several years in a managed care environment leading a network development/provider relations function, including proven experience leading contracting for Medicare products.
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Clearway offers all eligible employees working 20+ hours per week a comprehensive menu of benefits: generous PTO, medical, dental & vision care, HSAs with company contributions, health FSAs, dependent daycare FSAs, commuter benefits, relocation, & a 401(k) plan with employer match, a variety of life & accident insurances, fertility programs, adoption assistance, generous parental leave, tuition reimbursement, & benefits for employees in same-sex marriages, civil unions & domestic partnerships.
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The Regional Vice President will also provide executive leadership to the Provider Contracting, Provider Education and Provider Engagement in support of Humana's Commercial, Medicare, and Medicaid lines of business.
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tuition reimbursement a year provider contracting jobs Company: Centene Corporation in Mililani-town, Hawaii
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