16 to 30 of 6,448
Answer incoming phone calls from health care providers (i.e., physician offices, clinics) and identify the type of assistance the provider needs (EG. benefit and eligibility, billing and payments, authorizations for treatment, explanation of benefits) Average of 75 100 calls a day Focus on resolving issues on the first call, navigating through complex computer systems to
Posted 1 day ago
Researching and owning medical policies for Community and State (Medicaid business) Performing project work related to Value Creation projects Perform clinical research as requested through a health technology support line Auditing CPT, HCPCS and ICD 10 coding for medical policy documents and benefits for UHC ensuring we maintain compliance utilizing the appropriate codin
Posted 1 day ago
Assist in end to end on provider claims, provider information updates and help enhance call quality Assist in efforts to enhance ease of use of Provider Connect, MyAvatar and future services enhancements Assist in configuration of both rendering and contracting providers in MyAvatar, FACETS and provider directories Help implement training and development of external provi
Posted 1 day ago
Assesses and interprets customer needs and requirements Identifies solutions to non standard requests and problems Solves moderately complex problems and/or conducts moderately complex analyses Works with minimal guidance; seeks guidance on only the most complex tasks Translates concepts into practice Provides explanations and information to others on difficult issues Coa
Posted 1 day ago
Organize and provide home care services including medication administration, education and wound care among other responsibilities Coordinate with the RN supervisor to assure the client driven plan of care strives to meet positive outcomes through on going evaluation using evidences based practice Responsible for making certain the home care provided is compliant with sta
Posted 1 day ago
UHC Team Repricers ensure network contracts and reimbursement policies and procedures are priced accurately on affiliated medical claims Recommend system changes on provider contracts that appear inaccurate in the NDB (UHC Provider Network Database) Be able to assist with UHC projects and other tasks related to provider repricing, as necessary and / or requested Prioritiz
Posted 1 day ago
Solution, create, develop, manage, and author content for organization's web presence using Adobe Experience Manager (AEM) Copy edit and proofread all content Perform UAT and PAT in complex IT environments Coordinate digital projects across departments, agencies, and business partners Provide direction on content strategy to meet business needs and goals Work with legal,
Posted 1 day ago
Perform clinical coverage review services, which require interpretation of state and federal mandates, applicable benefit language, and consideration of relevant clinical information Function as a member of a self directed team to meet specific individual and team performance metrics Ability to communicate in writing and verbally, all types of benefit determinations inclu
Posted 1 day ago
Develop market business plans to motivate providers and large or complex group leadership to engage in improving Stars measures to be 4 STARS or higher Provide analytical interpretation of Stars and HEDIS reporting, including executive summaries to plan and provider groups Be the primary subject matter expert for all STARS related activities within their assigned market(s
Posted 1 day ago
Risk Adjustment and Quality Initiatives Perform analytics, quality assurance, and remediation of gaps in data Work with intake files and prepare submissions to multiple different health plans Identify best practices and key areas for improvement in clinical documentation and quality Monitor and report on program performance and outcomes Maintain a thorough understanding o
Posted 1 day ago
Understand the end to end environment of pharmacy claims processes including point of sale adjudication Support individual and team goals of affordability, excellence, engagement, compliance, and growth Support long term activities by influencing or providing input to forecasting and planning discussions by reviewing, implementing, and testing benefit coding requests in p
Posted 1 day ago
Work with a team of internal/external content creators/managers to deliver on already defined key objectives Contribute on the cross channel editorial calendar based on consumer insights and analytics Research and develop new content as needed (written and visual). Plan, develop, influence and distribute content such as blogs, social media, video, email, newsletters, info
Posted 1 day ago
Verify prescriptions and prescription data entered into the pharmacy computer system for accuracy Oversees the activities of pharmacy technicians and inventory personnel Organizes workload, sets priorities, completes assignments in a timely manner and utilizes resources appropriately while complying with department program standards Work in the fulfillment area to provide
Posted 1 day ago
Performs quality review audits on 100% of credentialing files, while maintaining a personal quality average of 95% or higher Takes ownership of the total work process to include system modifications and training, while providing constructive guidance to minimize problems and create efficiencies Maintains delegate files in accordance with the standards set forth by interna
Posted 1 day ago
$1,500 Sign On Bonus For External Candidates Combine two of the fastest growing fields on the planet with a culture of performance, collaboration and opportunity and this is what you get. Leading edge technology in an industry that's improving the lives of millions. Here, innovation isn't about another gadget, it's about making Healthcare data available wherever and whene
Posted 1 day ago
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