A medical benefits management solutions provider needs applicants for an opening for a Remote Associate Cardiology Medical Director. Must be able to: Provide expert medical review for service requests that do not meet criteria.
A healthcare company has a current position open for a Remote Senior Medical Economics and Informatics Specialist. Must be able to: Provide analysis on proposed rates and utilization targets. Partner with vendors to work through reconciliations or other analysis projects.
Core Responsibilities of this position include: Visiting MLTC and Managed Medicaid members in need of long term care. Conducting face-to-face UAS assessments. Supporting members with medication reviews and connections to services. Applicants must meet the following qualifications:
Analyzing and interpreting documentation from medical records. Completing accurate coding of hospital-based diagnoses. Communicating with providers for missing documentation or questions regarding documentation. Required Skills: Minimum of two years of experience required.
Qualifications for this position include: High School Diploma or GED. 2-3 years medical coding experience required in a physician setting. Formal coding education completed at an accredited certificate program – 1 year minimum. Basic computer, word processing, and 10-key skills.
Ensuring delivery of medically necessary, appropriate, timely, cost-effective and quality health care services. Reviewing retrospective, prospective, and concurrent reviews. Required Skills: Three years of utilization management or discharge planning.
Demonstrate a good working knowledge of medical terminology, human anatomy, and coding. Must possess knowledge of third party reimbursement regulations and billing practices. Possess moderate knowledge of level 1 and 2 modifiers.
5 years' experience working with senior - level c - suite executives. Background in Medical Benefit Management or similar services. Excellent negotiation / influence, collaboration, and listening skills. Proven ability to consult with clients to meet their business objectives.
Assisting members and their families / caregivers with connections to appropriate psychiatric, medical, and psychosocial referrals and services. Utilizing advanced clinical skills to engage and motivate Members and their families. Required Skills:
5+ years experience in a direct sales or account management role. Experience in a managed care pharmacy environment. Experience in reviewing and analyzing pharmacy and medical claims data. Proficiency with Microsoft Office with an emphasis on Excel and PowerPoint.