Essential Duties and Responsibilities: - Provides advanced clinical inquiry responses (verbal and written) to health-related inquiries from consumers, educators or medical/health professionals. - Provides medical subject matter expertise. - Performs advanced database searches. - Composes documents,
Essential Duties and Responsibilities: - Lead the development and implementation of advanced sourcing and category management strategies through the RFx process. - Oversee the negotiation and development of contracts with new suppliers and/or renegotiate existing contracts
Essential Duties and Responsibilities: - Organize project teams, assign individual responsibilities, develop project schedules, and determine resource requirements. - Oversee all facets of project operations. - Deploy resources to address all operational needs. - Make informed
Essential Duties and Responsibilities: - Provides customer service for basic and routine inquiries and problems via multiple possible channels (i.e. telephone, emails, web chats, or written letters). - Calls are predominantly routine, but may require deviation
Essential Duties and Responsibilities: - Review requests for services including admission, discharges and continued stays for adherence to clinical criteria, state and federal policy, and related requirements. - Issue approvals, denials or recommendations based on contract
Essential Duties and Responsibilities: - Facilitate and prepare all planning activities and artifacts for complex initiatives including project scope statements, work breakdown structure, and detailed project schedule. - Monitor schedule progress, and implement corrective measures as
Essential Duties and Responsibilities: - Update facility billing information. - Request claims and processing payment. - Ensure VES payments have been posted. - Confirm zero balances on patients accounts. - Mail zero balance letters to veterans
Essential Duties and Responsibilities: - Responsible for database administration, data consolidation, data analysis and management reporting. - Design database reports based on the requestors requirements in support of key business strategies. - Perform queries, data extraction,
Essential Duties and Responsibilities: - Supervise team members and processes to sustain an effective reporting program that gathers, prepares, trends, and analyzes operational activity. - Coordinate and evaluate the work of Reporting Specialist(s). - Assist with
Essential Duties and Responsibilities: - Facilitate the development of cross-line-of-business solutions by combining knowledge of business capabilities, value streams, and business processes. Consult with technical subject matter experts to develop technical solutions and advise on options,
Essential Duties and Responsibilities: - Support project management initiatives . - Schedule, plan, and coordinate project management activities. - Maintain project tracking tools and project documentation. - Communicate with project stakeholders. Job Specific Duties: - Build
Essential Duties and Responsibilities: - Provides advanced clinical inquiry responses (verbal and written) to health-related inquiries from consumers, educators or medical/health professionals. - Provides medical subject matter expertise. - Performs advanced database searches. - Composes documents,
Essential Duties and Responsibilities: - Works on assignments that are routine in nature, with responsibilities easily learned on the job. - Monitor call volume and staffing data to ensure workers are performing in accordance with established
Essential Duties and Responsibilities: - Assess and evaluate staff performance based on established goals and standards. - Identify and develop areas of opportunity for direct reports. - Manage QC supervisors performance management and tracking methods. -
Essential Duties and Responsibilities: - Works on assignments that are semi-routine in nature but recognizes the need for occasional deviation from accepted practice. - Follow procedures and directions to assess the quality of service provided through
Essential Duties and Responsibilities: - Supervise the work of call center staff to ensure adherence to quality standards, deadlines, and proper procedures, correcting errors or problems as needed - Interview and recommend hiring and promotion of
Essential Duties and Responsibilities: - Conduct Monthly 1x1 meetings with staff and evaluate employee performance and make recommendations on employee Bonus and Merit incentives. - Identify and set monthly individual/team goals. - Develop Quality Checklist, based
Essential Duties and Responsibilities: - Provide feedback regarding the design, development and distribution of training programs and materials as needed. - Conduct, plan, and coordinate training to a variety of audiences. - Coordinate logistics for instruction
Essential Duties and Responsibilities: - Audit medical records to ensure compliance with the Medicare Advantage Risk Adjustment standards including abstraction and assignment of appropriate codes based on clinical data. - Enter coded data into a system
Essential Duties and Responsibilities: - Lead the development and implementation of advanced sourcing and category management strategies through the RFx process. - Oversee the negotiation and development of contracts with new suppliers and/or renegotiate existing contracts