The Rates Configuration Specialist is responsible for configuring, maintaining, and updating rate tables and fee schedules within healthcare management systems. They also audit rate configurations for accuracy and collaborate with various departments to implement changes and resolve discrepancies.
MedPOINT Management
18 Remote Job Openings at MedPOINT Management
Credentialing Data Entry Clerk - Pacific Time Zone Applicants
MedPOINT Management
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Full Time
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9 days ago
MedPOINT Management
The role involves entering and maintaining accurate provider credentialing data and verifying applications, licenses, and certifications. The clerk will also audit provider records and coordinate with specialists to ensure regulatory compliance.
Credentialing Coordinator - Pacific Timezone Applicants
MedPOINT Management
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Full Time
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9 days ago
MedPOINT Management
Manage the end-to-end credentialing and re-credentialing process for healthcare providers, including primary source verification of licenses and certifications. Coordinate with medical staff and health plan partners to ensure timely approvals and ongoing compliance.
The role involves reviewing medical records to assign accurate HCC codes and ensuring compliance with CMS risk adjustment guidelines. The specialist will collaborate with clinical staff to clarify documentation and prepare reports to support risk adjustment programs.
HDO Credentialing Coordinator - Pacific Time Applicants
MedPOINT Management
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Full Time
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9 days ago
MedPOINT Management
Manage end-to-end credentialing and re-credentialing processes for healthcare delivery organization providers. Verify credentials and licenses in compliance with NCQA and regulatory standards while maintaining accurate provider records.
Manage and oversee regulatory cases from initiation to resolution while ensuring compliance with state and federal guidelines. Coordinate with internal and external stakeholders to process submissions, appeals, and grievances.
The role focuses on monitoring high-risk patients post-discharge to reduce preventable hospital readmissions. This involves coordinating care transitions between providers and developing individualized care plans.
The role involves reviewing, analyzing, and adjudicating inpatient and outpatient hospital claims according to plan guidelines. It also requires coordinating with providers and internal departments to resolve claim discrepancies and ensure regulatory compliance.
The Applications Specialist provides technical support, training, and troubleshooting for healthcare applications to ensure maximum uptime. They collaborate with cross-functional teams to optimize performance and assist in the implementation of new software solutions.
Review and analyze hospital claims for accuracy and compliance while resolving discrepancies with healthcare providers. Maintain detailed records and assist in developing claims processing guidelines to maximize reimbursement.
Provide first-level technical support for web portal users and monitor system performance to ensure optimal functionality. Collaborate with cross-functional teams to enhance portal features and document support processes in a knowledge base.
The role involves conducting patient assessments and collaborating with healthcare providers to develop and implement care plans. The manager is also responsible for monitoring patient progress, ensuring regulatory compliance, and facilitating communication between families and medical teams.
The role involves accurately entering and maintaining patient data within electronic health record systems while ensuring HIPAA compliance. Additionally, the clerk supports clinical staff by preparing data summaries and responding to administrative inquiries.
The role involves managing and responding to web inquiries professionally while coordinating with internal departments to resolve client issues. Additionally, the coordinator will analyze inquiry trends and collaborate with marketing to improve the online client experience.
Internal Audit Credentialing Specialist
MedPOINT Management
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Full Time
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20 days ago
MedPOINT Management
Conduct internal audits of credentialing files to ensure regulatory compliance and verify healthcare provider credentials. Maintain accurate databases and collaborate with teams to improve operational efficiency and reporting.
The role involves conducting utilization reviews for outpatient services and collaborating with healthcare providers to assess patient treatment plans. Additionally, the clinician manages insurance authorizations, appeals, and participates in quality improvement initiatives.
The role involves engaging with members through various channels to promote services, gather feedback, and assist with healthcare plan inquiries. The representative will also track engagement metrics and participate in community events to foster relationships.
The Client Account Manager acts as a strategic liaison between clients, healthcare providers, and internal teams to ensure seamless service delivery. They are responsible for resolving operational challenges, managing escalated issues, and monitoring account performance metrics.
