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Research client, State and Federal billing and reimbursement policies, client reimbursement practices (through review of manuals/regulations and meetings with stake holders) to develop and configure improper payment algorithms. Results will need to be organized, documented, and trained to other team members Reviews provider contracts to identify algorithms for the identification of contractual bas
Posted 1 day ago
Research client, State and Federal billing and reimbursement policies, client reimbursement practices (through review of manuals/regulations and meetings with stakeholders) to develop and configure improper payment algorithms with medium complexity. Results will need to be organized and documented with limited oversight. Reviews provider contracts to identify algorithms for the identification of c
Posted 1 day ago
Leads the planning and implementation of multiple routine and advanced level IT projects. Participates in facilitating the definition of project scope, goals and deliverables of routine projects. Participates in developing project tasks and resource requirements. Participates in developing full scale project plans. Provides knowledge and direction to less experienced staff. Understands project bud
Posted 2 days ago
Sr. Director, PHM Client Engagement (200010SF) The Sr. Director, PHM Client Engagement is responsible for supporting Vice President with the overall service delivery and satisfaction of assigned commercial clients. Specific responsibilities include achieving revenue and margin goals, ensuring quality and timeliness of client deliverables, identifying and assisting with the development and executio
Posted 3 days ago
Sr. Director, PHM Client Engagement (200010SE) The Sr. Director, PHM Client Engagement is responsible for supporting Vice President with the overall service delivery and satisfaction of assigned commercial clients. Specific responsibilities include achieving revenue and margin goals, ensuring quality and timeliness of client deliverables, identifying and assisting with the development and executio
Posted 3 days ago
Perform Level II Delivery and Product Analysis using documented research methods Conduct basic research on issues and requests via ConnectUs in a timely manner that may not be documented in an SOP for the responsible products Use and update SQL code for deliverable processing Identify and escalate missing data (inputs) to Production Support and Supervisor for immediate action Create basic SQL code
Posted 3 days ago
Independently produces and analyzes various business process maps and reports in support of realizing project plan goals. Supports day to day operation in assigned process area by responding to requests for research or minor changes to workflow Builds and deploys operation reporting suites and tools. Keeps all stake holders updated on project timelines, due dates and outstanding items Provides reg
Posted 3 days ago
Develops and manages budget and revenue expectations for a specific group of clients Serves as primary liaison with clients. Develops and maintains a depth and breadth of client relationships, including at the C level. Works with company wide resources to ensure key client deliverables and revenue goals are met or exceeded. Identifies additional sources of revenue through use of sales and marketin
Posted 4 days ago
Responsible for the planning and implementation of one or two routine level IT projects. Participates in facilitating the definition of project scope, goals and deliverables of routine projects. Participates in developing project tasks and resource requirements. Participates in developing full scale project plans. Provides knowledge and direction to less experienced staff. Understands project budg
Posted 4 days ago
Execute the annual and three year strategic planning processes Lead management and measurement of key strategic initiatives Spearhead multi disciplinary planning projects; scope of responsibility ranges from ownership of a single project deliverable to a discrete workstream within a complex engagement Demonstrate ability to perform analyses in the following domains Go to market strategy Geographic
Posted 4 days ago
Analyze and improve business processes to improve overall workflow efficiencies and effectiveness. Document processes and procedures using standard methodologies and tools. Apply process improvement and reengineering methodologies and principles to identify and plan improvements (process and technology) including identifying the current process, applying best practices, and creating performance me
Posted 4 days ago
Oversees assigned accounts and ensures that strong working relationships are maintained with internal and external customers. Prepares, monitors, and manages budget and revenue expectations for all assigned books of business. Supports collaboration between CR team and all other HMS departments. Reports to management on progress toward strategic carrier growth and opportunities. Ensures that all st
Posted 4 days ago
Perform a clinical review of medical records and/or other documentation to determine that services billed to and paid by the Medicaid agency are supported. This includes review for correct coding and medical necessity. Complete medical review form, accurately documenting findings, and provide policy/regulatory support for determination. Conduct research on relevant State specific billing/reimburse
Posted 4 days ago
PHM Account Executive (200010S6) Responsible for the successful sales and delivery of HMS' Eliza and Essette services to multiple clients including Health Plans and other At Risk entities. Responsible for business development in both new and current relationships and revenue generation within an assigned book of business and or region. Essential Functions Leverage consultative sales approach to ga
Posted 4 days ago
Oversees the sales and delivery of services across region. Effectively manages all regional operations to ensure high performance and efficiency. Builds a strong regional organizational plan that mitigates risks and facilitates future growth. Develops strong relationship with commercial insurance stakeholders, including associations, advisory groups and business development influences. Manages the
Posted 4 days ago
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