Ability to maintain a high level of confidentiality, work independently, and handle stress effectively despite short time constraints while displaying a can-do attitude., Sales compensation experience, specifically creating and maintaining sales commission plans, highly desirable.
This position is responsible for leading a team that manages member premium billing and remittance, member reimbursements, as well as reconciling Centers for Medicare and Medicaid Services (CMS) payments made to the plan. This team will also provide financial analytics in support of P&L reporting. In addition, this role will interface and coordinate activities with multiple internal Magellan business units.
e are completely and accurately reporting diagnostic information to the Center for Medicare and Medicaid Services. This position is responsible for maintaining current practices in this area as well as developing new and innovative initiatives. This role will work with the extensive information the company already collects on members and use it to improve revenue accuracy.
Tool based on guidelines and training provided by the company and/or outside resources. Responsible for completion, correction and revision of UAS, paperwork, and tasking tool documentation based on review and feedback provided through quality and associated review processes.
Develops and sustains an interface with client forums, facilitates the delivery of appropriate care and contributes to the development of the clinical mission of the business, including the development, implementation, execution, and evaluation of clinical prior authorization and coverage determinations.
Collects, analyzes and prepares record/documents information for projects related to assessing the efficiency, effectiveness and quality of the delivery of managed care services. Prepares monthly performance reports with audit results. Presents findings at provider, customer, UM and CM meetings as needed.
Ensures revenue goals are met, cost of care and administrative expenses managed, and (Earnings before Interest, Depreciation, Taxes and Amortization) EBIDTA targets achieved for the assigned account(s)
This position services as an expert technical and industry resource to management, clients and development staff in new uses of information technology and in all phases of major system and subsystem development. Provides consultation on internal and industry IT technical and business process capabilities including leadership in the identification and recommendation of new IT opportunities.
This position services as an expert technical and industry resource to management, clients and development staff in new uses of information technology in all phases of major system and subsystem development.
This position will analyze problems and is an expert in at least two or more Data Management tools. Role will understand and develop requirements for a system (mapping documents) by working with Business and Stakeholders, including visualization.
Formulates, contributes to, and directs task identification, work effort estimates, and work schedules for research, prototype, and proof-of-concept IT activities. Directs and participates in software/hardware releases and installation tasks.
Ensure the collection of customer, stakeholder and community feedback to identify key issues and inform/refine overall outreach strategy. Works closely with corporate marketing and other corporate functions, and ensures areas of responsibility between health plan and corporate functions are clear.
Home Care, Long-Term Care, MLTC experience preferred, including appropriate support services in the community and accessing and using durable medical equipment (DME). Experience in utilization review, concurrent review and/or risk management a plus.