, 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...
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...
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...