Departments including Office of Payment Transformation, Finance and Accounting, Medical Management, Medicare and Medicaid Programs..., Finance and Accounting, Quality Management, Provider Operations, Medical Management, Office of Payment Transformation...
/management experience. Strong written and verbal communications skills. Strong customer service skills. Strong process...
, but not limited to, HMSA's provider contract definition, application of payment or medical policies, provider operations that involve..., reimbursement, policies, promotion of self-service tools, and support of various complex HMSA programs. Participates and attends...
Job Description: Requirement Intake and Analysis Conduct impact assessments of new and revised BCBSA licensure requirements. Collaborate with operational owners, Legal, Enterprise Risk Management, Compliance, and the Program's Offic...
Job Description: Program Coordination and Administrative Oversight Coordinate and schedule meetings for the BCBSA Licensure Governance Steering Committee, Compliance leadership, and other key stakeholders. Organize and maintain prog...
. Interacts with corporate decision-makers (e.g., HMSA Board members, executive and senior vice presidents, and Medical Directors...
Job Description: Resolve enrollment, eligibility and billing issues and inquiries timely and accurately from members, employer groups and third party administrators by phone, email and written correspondence by: Researching and colla...
a multi-disciplinary team to develop a person- centered care plan to include but not limited to member's PCP, other service... others in order to ensure timely access to appropriate medical care, behavioral health care, and services. Document and resolve...
and updates for the Quality Management SharePoint site. Coordinate, facilitate and conduct ad hoc medical record requests... communication reviews. Support service portal requests as needed to ensure appropriate access in support of programs...
taking Corporate Operator calls to meet service level expectations. Develop and maintain plan for Corporate Operator trained... with equipment needed to service. Performs all other miscellaneous responsibilities and duties as assigned or directed...