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Description The Risk Adjustment Representative Specialist travels to provider offices within the region and scans medical records into a secure system. The records are reviewed by Humana's Coding staff. How we ..
Job Information Humana RN, Compliance Nurse 2 (Quality Assurance Audit) - Remote in Tampa Florida Description The RN, Compliance Nurse 2 reviews utilization management activities and documentation to ensure adherence to ..
Description Responsibilities As part of the Service Fund Specialty Load Team, the Senior Provider Installation Professional will work directly with our national and market contracting teams to influence specialist contract terms ..
Description The UM Administration Coordinator 2 contributes to administration of utilization management. The UM Administration Coordinator 2 performs varied activities and moderately complex administrative/operational/customer support assignments. Performs computations. Typically works on ..
... for exams and procedures with specialists and providers outside of the ... Qualifications 1-3 years of hands-on healthcare experience in a clinical setting, ... Preferred Qualifications Bachelor's Degree in..
... is looking for an experienced Healthcare Investigator to join its industry ... areas Bachelor's degree or significant healthcare fraud and investigation experience At ... At least 1 year of..
Description The Care Manager, Telephonic Nurse 2 employs a variety of strategies, approaches and techniques to manage a member's physical, environmental and psycho-social health issues. Identifies and resolves barriers that hinder ..
The Patient Government Accounting Analyst plays a crucial financial role in minimizing bad debt and maximizing revenue to meet Genesis HealthCare Business Excellence goals. RESPONSIBILITIES/ACCOUNTABILITIES:Ensure claims/bills are produced according to payor ..
Description The Medical Record Retrieval Specialist (Risk Adjustment Representative) travels to provider offices within the region and scans medical records into a secure system. The records are reviewed by Humana's Coding ..
... 40 market leader in integrated healthcare whose dream is to help ... and enrollment, Claims, Encounter Reporting, Payment Integrity, Member Call Center, Provider ... (typically 8 years) working in..
Description The Claims Research & Resolution Professional 2 works with enterprise shares team comprised of calls/claims/contracting and external provider associates researching the resolution to a pending inquiry. Understands department, segment, and ..
Description The Supervisor, Pre-Authorization Nursing reviews prior authorization requests for appropriate care and setting, following guidelines and policies, and approves services or forward requests to the appropriate stakeholder. The Supervisor, Pre-Authorization ..
Job Information Humana Pre- Authorization Nursing Supervisor-- REMOTE/WORK AT HOME (Anywhere in the US) in Tampa Florida Description The Supervisor, Pre-Authorization Nursing will be managing the team that reviews prior authorization ..
... looking for an experienced Senior Healthcare Investigator to join its industry ... Qualifications Bachelor's degree or significant healthcare fraud and investigation experience At ... At least 3 years of..
Description iCare is seeking an Enrollment Specialist who will support the iCare enrollment processing duties for all lines of business including Medicare, Medicaid, Family Care Partnership (FCP) and BadgerCare Plus. Responsibilities ..
Description The Behavioral Health Medical Director responsible for behavioral health care strategy and/or operations. The Behavioral Health Medical Director work assignments involve moderately complex to complex issues where the analysis of ..
Description The Risk Management Lead - Home Health works as a partner with Home Solutions teams to evaluate and analyze business processes, potential issues, and strategic opportunities to minimize risk, ensure ..
Description The Medical Director relies on medical background and reviews health claims. The Medical Director work assignments involve moderately complex to complex issues where the analysis of situations or data requires ..
Description The Supervisor, Care Management Support contributes to administration of care management. Provides non-clinical support to the assessment and evaluation of members' needs and requirements to achieve and/or maintain optimal wellness ..
Description The Medical Director relies on fundamentals of CMS Medicare Guidance on following and reviewing appeals for Medicare Part C Line of Business. The Medical Director provides medical interpretation and determinations ..
