Audit paid claims data to identify case overpayments Examine, assess, and document business operations and procedures to ensure data integrity, data security and process optimization Investigate and resolve overpayments on all claims types, as well as assist in recovery and resolution for health plans, commercial customers, and government entities as needed Work directly

Gather business requirements, defining capabilities, acceptance criteria and development prioritization with technology partners Manage the capability and its usage across businesses across the lifecycle, using a defined development process Documents and translates business needs into high level capability requirements and user acceptance criteria Engage with the Business

Practices in accordance with the respective state laws and regulations governing the practice of advanced practice nursing Understands and complies with long term care policies and procedures, including those that regulate nursing facilities and assisted living communities Establishes and maintains effective relationships with members and their legal representatives, faci

Provides consistent professional nail care to include trimming and buffing of toenails Organizes exam and treatment rooms, replenishes stock levels, cleans rooms and sterilizes medical instruments Keeps inventory of supplies and places replenishment orders as needed Returns any and all patient messages in a timely manner Attends, participates in and supports training and

Act as a recognized voice of the customer to the team, on behalf of the business Establish, develop and maintain effective relationships with applicable project stakeholders (e.g., project team members, team leads, internal customers, functional SMEs, business partners, leadership) Develop a deep understanding of the customer and product needs Represent the business with

Manages ongoing contract relationships and service delivery to clients for one or more accounts Acts as outward facing, dedicated resource for assigned accounts, typically with direct client contact (not call center) and mid size accounts Builds relationships with employer / group clients (not individual members) Represents client internally and coordinates with other fun

Takes ownership of facilities in assigned market(s) Manages assigned work orders in ServiceNow (or other software) Completes notes and closes work orders to customer's satisfaction Responds to telephone calls and e mails for facilities support, ensuring steady communication with customers. Escalates issues to management when necessary Orders materials and services when ne

Coordinate and supervise daily/weekly/monthly activities of a team members Set priorities for the team to ensure task completion and performance goals are met Coordinate work activities with other supervisors, managers, departments, etc. Identify and resolve operational problems using defined processes, expertise and judgment Provide coaching, feedback and annual performa

Develop, implement and maintain processes and procedures for accurate and timely analysis of financial data, ensuring best practices; Develop and maintain internal control structure and procedures for financial reporting; Resolve high level financial reporting issues; Manage the audit process and work with outside auditors regarding accounting and reporting issues; Overse

Process 51 100 quote requests as assigned in the inventory tracking system Review documents and market reference tools to create a 51 100 Fully Insured and / or Self funded quotes Work with internal and external contacts to gather missing information and clarify data that was submitted Use appropriate quoting system to process quotes for 51 100 non Community rated busines

Assist physicians and nursing personnel with injections, EKGs, phlebotomy and other patient care procedures Maintain established quality control standards Record and process patient care documentation quickly and accurately Coordinate patient care as directed by physicians, company standards and policies Organize, stock and clean exam and treatment rooms and sterilize ins

Performs all duties within the scope of a Medical Assistant's practice. Operates diagnostic equipment (cannot interpret tests), remove staples from superficial wounds, changes wound dressing and obtains cultures, administers non intravenous medication, performs simple specimen collection via noninvasive techniques and collects blood specimens via venipuncture or via capil

Supports the gathering and documenting of business requirements Understands and helps to clarify business/technology problem Identifies and gathers non functional requirements Actively participates in the adopted software methodology Actively participates in ensuring high quality solution and applies understanding of testing methodologies Possesses basic business knowledg

Haras parte de la multinacional de servicios de salud mas grandes del mundo y en proceso de expansion en Colombia. Buscamos SUBGERENTE DE FIDELIZACION para la ciudad de Bogota. Requisitos para el cargo Profesional en carreras como Ingenierias, Administracion de Empresas o afines. Especializacion en areas administrativas o afines 4 anos de experiencia, con conocimientos En

Work with leadership to analyze business needs and prioritize all the potential automation opportunities Gain a deep understanding of the provider healthcare market to truly understand the client needs Develop new automations for the high impact work based on the priorities Design automation approaches with the long term architecture in mind Coordinate with offshore devel