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Provides depth of pharmacy underwriting capabilities and increases capacity to build and maintain financial models, plan design and pricing strategies and support trend analysis for self funded clients. Assists management by measuring financial risk and performance at the client level and the line of business level. Reviews information and data and makes recommendation for pharmacy cost structure/
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Directs development and maintenance of provider network. Provides guidance and direction over staff responsible for any or all of the following areas within the network provider relations, provider contracting, recruitment, fee negotiations, customer services, credentialing, and database management Description 60% Develops and maintains provider network. Directs and oversees activities and staff
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Manages and coordinates the development of new business as needed to grow revenue for the company within identified markets and solutions. Identifies, pursues, and wins new business. Develops and recommends account plan and marketing approaches, and related changes as needed to reach sales goals and objectives. Prospects and develops leads leading to requests for proposals (RFP's) and sole source
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Description 50% Provides clinical expertise, research, and judgment to develop Local Coverage Determinations(LCDS) under the direction of medical director. Maintains LCDS once developed. 35% Educates providers and internal customers on LCDS. Communicates with other interdepartmental staff in appropriate coding and reimbursement guidelines to ensure coordination and compliance. 15% Provides clinic
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Ensures that the Local Coverage Determination (LCD) process adheres to contract instructions. Creates, implements, and maintains educational tools to help providers reduce the submission of claims for non covered services and reduce the claims payment error rate. The error rate is a factor in awarding and renewing Medicare/other contracts. Description 50% Provides clinical expertise, research, a
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Provide molecular diagnostic expertise to suggest improvements on the standardization of processes for provider coverage determinations. Focus is reviewing molecular, genetic, and esoteric tests for unique characteristics. Provide guidance on updates and improvements to identifiers and development of processes. Description Job Duties 75% Reviewing/assigning/maintaining unique identifiers for reg
Posted Today
Provide molecular diagnostic expertise to suggest improvements on the standardization of processes for provider coverage determinations. Focus is reviewing molecular, genetic, and esoteric tests for unique characteristics. Provide guidance on updates and improvements to identifiers and development of processes. Description Job Duties 75% Reviewing/assigning/maintaining unique identifiers for reg
Posted Today
Responsible for group and individual product sales and marketing/promoting products at events through the use of the BlueCross Mobile Unit. Provides sales and service to customers seeking insurance at community events. Responsible for set up and clean up of the Mobile Unit. Maintains current knowledge of all assigned insurance products. Customarily and regularly engaged in outside sales. Descript
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Responsible for the most complex activities associated with maintaining ledger accounts and/or for developing financial statements and/or reports. Analyzes complex financial data and/or reports on the results and/or probable implications. Compiles financial information, processes journal entries into various accounts, and/or reconciles reports and/or financial data. Description 20% Exercises acc
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Develops difficult statistical analysis using standard reporting, AD HOC reporting, and data mining tools in order to identify patterns and trends. Prepares charts, illustrations, and other graphics and narrative reports to identify and explain data findings. Description 30% Develops, maintains, and executes complex database programs for the extraction and presentation of data for standard and a
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Responsible for group and individual product sales and marketing/promoting products at events through the use of a recreational vehicle (RV). Provides sales and service to customers seeking insurance at community events. Responsible for set up and clean up of the RV. Maintains current knowledge of all assigned insurance products. Customarily and regularly engaged in outside sales. Description 40
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Directs and coordinates all components for the development of new business as needed to grow revenue for the company within identified markets and solutions. Identifies, pursues, and wins new business. Evaluates marketing plans to meet ever changing market and competitive conditions. Identifies short term and long term pursuit approaches. Develops and recommends account plan and marketing approach
Posted Today
Responsible for providing a full range of financial, compliance, and operational audits, business advisory, and consultation services, investigations, internal controls, accountability, and use of resources. Description 50% Conducts internal and/or external timely operational, financial, and/or compliance audits of divisions, departments, providers, and activities of the corporation including e
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Performs medical reviews using established criteria sets and/or performs utilization management of professional, inpatient or outpatient, facility benefits or services, and appeals. Documents decisions using indicated protocol sets or clinical guidelines. Provides support and review of medical claims and utilization practices. Description 80% May provide any of the following in support of medica
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Under general supervision, performs a variety of routine to moderately complex clerical/accounting functions such as inventory balancing, reconciliations, generating refund request letters, processing disbursements and deposits, keying journal entries and logging items in accordance with standard procedures in one or more of the following areas; general accounting, accounts payable, accounts recei
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