for non-covered or nonparticipating provider services in addition to soliciting claims and other related medical information... to resolve them upon initial inquiry to best service the member as well as minimize the number of cases escalated to senior...
Job Description: Assessment Provide telephonic screening of BH members using PHQ-9, GAD, and other CM-DM diagnostic tools to determine additional care support needs. Communication Communicates with HMSA members, physicians, case...
's position and concerns to management and decision makers. Triages cases to resolve them upon initial inquiry to best service...
-dependent tasks and deliverables. Assesses vendor performance against contract specifications and service level agreements. Acts...
Job Description: Design Solutions: Serve as a technical leader on our most demanding, cross-functional projects. Balance technical leadership with strong business judgment to make the right decisions about technology choices. Decom...
and promote HMSA's brand message and commitment to service excellence. Build enduring relationships with HMSA's customers/members... service experience for anyone with questions regarding health care, health insurance (benefits, claims, premiums, payments...
to support Medicare Programs initiatives to improve our medical, drug and other health related products to ensure HMSA remains... Cross Blue Shield Association and Plans, HMSA partners, vendors and downstream entities to continuously add value...
Job Description: Coordinate and monitor activities with appropriate MP and operational departments to ensure that standards are being met timely and accurately;escalate issues as needed. Conduct analysis of ad hoc and questions, researc...
, membership enrollment, claims processing, financial statements, customer service, provider contracting, quality improvement...
Job Description: Utilize medical necessity criteria from established medical policies and clinical practice... guidelines to render precertification determinations as described in the Medical Management UM work plan. This detailed clinical...