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A&G Clinical Specialist

FL Req ID: R016503 Remote
Duties and Responsibilities: Responsible for case development and resolution of clinical cases, such as: Pre-existing Conditions, Prior Approval, Medical Necessity, Pre-certification, Continued Stay, Reduction, Termination, and Suspension of services. The end to end process requires the...
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Accountant

FL Req ID: R018725 Hybrid
Ensure all accounts are reconciled on a monthly basis and work with other stakeholders within Finance such as the EMR team, STAT team, Actuarial and Accounts Payable to ensure accounts are maintained accurately and so that they balance each month and are ready for audit, accurate reporting and...
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Analyst

NY Req ID: R019820 Remote
•Process all lockbox files into Managed Healthcare Systems (MHS). Ensure all member payments are accurately processed to the appropriate account using the matching criteria and online decision•Perform account analysis to ensure member balances are accurate and account balance is updated•Process...
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Assessment Nurse

NY Req ID: R018751 Hybrid
Duties and Responsibilities: Conducts home assessments for prospective members and re-assessments of current members using the Uniform Assessment System (UAS); make enrollment and continued eligibility determinations by utilizing clinical expertise and critical thinking skills.  As...
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Avature Test - Manager

NY Req ID: R016450 Remote
Partners with Director of Benefits in support of the company’s employee benefit, recognition, and retirement program strategy and administration, including open enrollment Conducts benefits analyses, researches benefits practices, and operationalizes programs to improve employee health, wellness,...
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Budget Analyst

CT Req ID: R018721 Hybrid
Lead annual operating plan and quarterly forecast process.Partner with business leaders to meet the operational budget requirements for area of responsibility.Review and monitor staff work providing training, evaluation and direction.Perform review and analysis of membership, headcount, and...
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Business Analyst

NY Req ID: R018765 Hybrid
Duties & Responsibilities:Review, analyze and create all General Ledger (GL)reports monthly (e.g., Revenue, AFDA; Write offs).Support the AR balance by compiling the details of all DENY/PEND/Unprocessed and Rate Change reports. Support and report AR sub-ledger aging and collections.System...
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CCO Sr Service Agent

NJ Req ID: R018700 Remote
Duties and Responsibilities ·       Provides high quality assistance to the team via phone, chat, video call, email, in person, and/or other communication channels related to servicing our members and/or providers. May include but is not limited to inbound/outbound calls/emails/chats,...
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Chief Clinical Officer

NY Req ID: R019835 Hybrid
Manages and oversees team to sets the strategy, direction, policies, and goals for Healthfirst’s Clinical departmentsInterfaces with the Board of Directors, CEO, regulators, and other medical employees on clinical and quality initiativesMakes recommendations to the CEO on medical issues related...
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Chief Operating Officer

NY Req ID: R019836 Hybrid
Responsible for the daily operations of the organization Plans, directs, conducts, and evaluates operational activities of the organization Develops, recommends, and oversees implementation of objectives, plans and policies for the organization; Directs the organization’s operations to ensure...
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Claims Implementation Analyst

FL Req ID: R018713 Remote
Duties & ResponsibilitiesAnalyze contract terms, prepare fee schedules and accurately document file changes into the claims processing system Research and identify published updates to payment methodologies, fee schedules and claims editing policies from Medicare, Medicaid, and third-party...
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Claims Supervisor

NY Req ID: R018726 Hybrid
•Responsible for the oversight of claims processing workflow from time of receipt to final adjudication. Review status and inventory reports to ensure acceptable levels are maintained. Alert management to issues affecting timeliness and accuracy of processing and develop plans to...
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Clinical Director

Req ID: R019818 Remote
Duties/Responsibilities:Examines provider claims and service authorizations for completeness, accuracy, and medical necessity and proposes resolutions per internal and regulatory processes.Communicates to relevant teams and providers any claims/ authorization inaccuracies found along with...
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Compliance Administrator

Req ID: R019819 Remote
Assists in implementation of companywide compliance initiatives, policies and procedures such as Conflict of Interest, Vendor Compliance Program, Compliance Training and Compliance Program Effectiveness. Utilize project management skills to assess compliance program risks, facilitate and monitor...
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Confidential hire Acturail

NY Req ID: R018762 Hybrid
Duties and Responsibilities:Monitoring performance on all lines of business and update forecasts as appropriateResponsible for EMR actual versus budget/forecast variance analytics in each monthly closeBuild and maintain Healthfirst’s quarterly forecast models.Responsible for Medical Cost trend /...
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Confidential Test Manager

Req ID: R016499 Remote
Identify, assess and screen candidates for requisitions or job groups within specific business areas. Develop robust sourcing strategies that will deliver robust talent pipelines Review candidates that have applied to requisitions to identify those with the qualifications to be phone...
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CW Test

NY Req ID: R016476
Communications: Effective facilitator in client management and/or technical discussions, in developing and delivering presentations, and clearly communicating issues to SMC Leadership. Client Delivery:  Take ownership in delivering high quality, on budget work, with high client...
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