The Support Coordinator assists care managers with non-clinical tasks such as creating cases, conducting telephonic outreach, and managing service authorizations. They are responsible for documenting member and provider interactions while ensuring accurate communication across departments.
The Support Coordinator assists care managers with non-clinical tasks such as creating cases, conducting telephonic outreach, and managing service authorizations. They are responsible for documenting member and provider interactions while ensuring accurate communication across departments.
The Senior Claims Coding Analyst serves as a subject matter expert to optimize provider dispute resolution and identify systemic root causes. They analyze dispute trends to implement standardized, automated solutions while ensuring regulatory compliance and payment accuracy.
The Clinical Specialist manages member and provider appeals and grievances by investigating clinical cases and ensuring compliance with regulatory standards. They are responsible for case development, preparing documentation for medical reviews, and resolving issues related to service authorizations.
The Software Production Support Lead ensures the stability and performance of products by managing ticket escalations, performing root cause analysis, and coordinating with cross-functional teams. They are responsible for tracking SLAs, generating performance metrics, and providing technical guidance to resolve issues efficiently.
The analyst will drive compliance reporting, monitor pharmacy benefit manager performance, and automate data validation processes. They will also identify and target members for medication therapy management programs while ensuring data integrity and regulatory adherence.
The Support Coordinator assists care managers with non-clinical tasks such as managing authorizations, creating cases, and conducting telephonic outreach to members and providers. They are responsible for maintaining accurate documentation, ensuring HIPAA compliance, and providing high-quality customer service to resolve member and provider inquiries.
The Manager of Clinical Appeals and Grievances leads a team to standardize and optimize appeal processes while ensuring compliance and high-quality case resolution. This role collaborates with organizational leaders to identify priority focus areas and manages internal and external production teams to meet performance targets.
The Outreach Retention Specialist is responsible for managing member outreach and retention efforts to support organizational goals. They will engage with members to ensure service continuity and address inquiries effectively.
The Clinical Specialist manages member complaints, grievances, and appeals by conducting clinical case development and resolution. They ensure compliance with federal and state regulations while managing caseloads and preparing cases for medical director review.
The analyst leads end-to-end forecasting and capacity planning for multichannel contact center operations, ensuring strategic alignment and performance oversight. They translate demand forecasts into actionable staffing strategies while driving continuous improvement in models and methodologies.
The Vendor Partner Specialist manages relationships with external vendors to ensure service level agreement adherence and quality auditing. They act as a liaison between department leaders and vendors to coordinate workflow, training, and process improvements.
The Medical Peer Reviewer consults on medical necessity within utilization management, ensuring adherence to internal and external regulations by assessing authorization requests and claims payments based on medical records. This role involves rendering determinations within regulatory timeframes, maintaining productivity standards, and collaborating across various medical and management departments.
