The Payment Integrity Analytics Specialist is responsible for developing dashboards, reports, and analytical insights to support payment integrity operations and FWA prevention. This role collaborates with cross-functional teams to transform data into actionable business insights for operational decision-making.
The clinician facilitates client wellness through comprehensive assessment, care planning, and resource coordination to ensure safe and cost-effective healthcare outcomes. They act as a liaison between patients, providers, and payers while maintaining adherence to regulatory standards and privacy laws.
The Mental Health Parity Coordinator supports enterprise compliance with federal and state mental health parity laws, including the Mental Health Parity and Addiction Equity Act. This role coordinates parity analyses, documentation, and reporting while partnering with internal teams to identify risks and ensure compliant benefit administration.
The Care Management Clinician facilitates client wellness through assessment, planning, and coordination of healthcare services. They act as an advocate and resource manager to ensure safe, cost-effective, and client-centered care delivery.
The Utilization Management Clinician assesses member health information and coordinates resources to ensure cost-effective, quality healthcare outcomes. They perform concurrent reviews, manage preauthorization requests, and serve as a primary resource for members navigating the health system.
This role oversees the Provider Network department's core operational, data, and systems functions, including credentialing, provider relations, and platform interoperability. The director leads strategic planning and execution to ensure high performance across all lines of business while fostering partnerships and optimizing system compatibility.
The Senior Fraud, Waste and Abuse Investigator manages complex healthcare audits and investigations to ensure compliance with state and federal regulations. They collaborate with cross-functional teams to identify patterns of fraud, conduct fact-finding interviews, and serve as a subject matter expert for the organization.
The Senior Fraud, Waste and Abuse Investigator manages complex healthcare audits and investigations to ensure compliance with state and federal regulations. They collaborate with cross-functional teams to identify patterns of fraud and present findings to management and regulatory agencies.
The Senior FWA Specialist serves as a subject matter expert responsible for developing and maintaining the organization's Payment Integrity and Fraud, Waste, and Abuse programs. This role leads investigations, manages regulatory reporting, coordinates audits, and collaborates with internal and external stakeholders to mitigate financial risks.
The Senior FWA Specialist serves as a subject matter expert responsible for developing and maintaining the organization's Payment Integrity and FWA program framework. This role involves leading investigations, managing regulatory reporting, coordinating audits, and collaborating with internal and external stakeholders to prevent and recover fraudulent payments.
The Senior FWA Specialist serves as a subject matter expert responsible for developing and maintaining payment integrity and fraud, waste, and abuse programs. This role involves coordinating audits, managing regulatory reporting, and collaborating with internal and external stakeholders to detect and prevent financial risks.
The Senior FWA Specialist serves as a subject matter expert responsible for supporting and advancing payment integrity and fraud, waste, and abuse programs. This role involves developing policies, managing audits, coordinating with regulatory agencies, and analyzing claims data to identify and mitigate financial risks.
Develop and administer compensation programs to support the company's philosophy and talent retention. Manage direct compensation administration, conduct market benchmarking, and ensure compliance with federal and state laws.
The Senior Risk Adjustment Analyst ensures accurate data submission to regulatory entities like CMS and optimizes risk models for HCCs and HEDIS performance. The role involves collaborating with internal and external partners to improve processes, maintain documentation, and provide mentorship to junior analysts.
The Senior Risk Adjustment Analyst ensures accurate data submission to regulatory entities like CMS and optimizes risk models for HCCs and HEDIS performance. The role involves collaborating with internal and external partners to improve processes, maintain documentation, and provide mentorship to junior analysts.
