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Completes review of both medical documentation and claims data to assure appropriate resource utilization, identification of opportunities for Case Management, identify issues which can be used for ed...
Maintains confidentiality of member and case information by following corporate and divisional privacy policies. Accountable for timely and comprehensive review of clinical data with concise documenta...
Monitor, oversee and audit to ensure claims are handled in compliance with statutory and regulatory requirements; take prompt action to resolve all complaints/discrepancies; inform leadership of any s...
Manage procedural and training documentation, adverse events reporting, source data collection and analysis, CT and echocardiographic images, technical case evaluations etc...
Work with Senior Coverage Litigation Attorney on all aspects of litigated files including discovery, depositions, motion practice and trial. Some authority to negotiate settlements with plaintiffs’ at...
Develop business cases for strategic initiatives; design and set up cross-functional programs to drive these initiatives; lead one or more transformation initiatives by building strong partnerships wi...
Serves as the primary day to day contact for a potential client, including reviewing the work of the experienced analysts and serving as the coordination point for the functional, products and transfo...
Responsible for maintaining and ensuring the integrity and confidentiality of all employee personnel data within Workday, addressing quality issues and identifying the route cause and actions to impro...
The role of the Revenue Cycle Solution Design team is to complete assessments and detailed due diligence to identify financial and operational opportunities at potential clients and internal business...
Collaborate with the various Product Owners (ERP, eCommerce, Content, etc.) to ensure the impact of non-Finance initiatives on the Finance team and processes are fully considered and proactively manag...
Knowledge of and ability to effectively use the appropriate modeling methodologies and tool-sets, requirements management methodologies and tool-sets, requirements visualization methods and tool-sets...