Transforming the health of the communities we serve, one person at a time.
Provider Reimbursement Specialist
Location
United States
Posted
63 days ago
Salary
$56.2K - $101K / year
Seniority
Mid Level
No structured requirement data.
Job Description
Provider Reimbursement Specialist
Centene Corporation
You could be the one who changes everything for our 28 million members. Centene is transforming the health of our communities, one person at a time. As a diversified, national organization, you’ll have access to competitive benefits including a fresh perspective on workplace flexibility. Must be authorized to work in the U.S. without the need for employment-based visa sponsorship now or in the future. Sponsorship and future sponsorship are not available for this opportunity, including employment-based visa types H-1B, L-1, O-1, H-1B1, F-1, J-1, OPT, or CPT. Applicants for this job have the flexibility to work remote from home and preferably reside in New York or within the tri-state area. Position Purpose: Maintains relationships with physicians, hospitals, ancillary providers and Health Net's internal Provider Network Management Dept. Acts as first line contact for providers/hospitals on claims projects and other non-routine claim issues. Oversees, in conjunction with the Adjustment and New Day Unit Supervisors, resolution of project issues and is responsible to communicate final resolution to the provider/hospital or other business units and/or managers, as needed and/or as required. Assists with policy and procedure interpretation. Researches, analyzes and resolves complex problems with claims development and finalization. - Assists with complex claim issues and acts as the first line contact for providers on large projects and non-routine claim issues - Manages projects in conjunction with assigned adjusters and/or regional units for research, analysis and resolution - Responds directly to the providers with final resolution of the issues, up to and including: root cause documentation/feedback, necessary corrective action plans and/or process improvement initiatives - Conducts routine periodic site visits to providers/physicians/facilities - Participates with Network Management in Joint Operating Committee (JOC’s). - Coordinates with Provider Network and Provider Data Management for contract data corrections - Identifies and reports to Provider Network Management contracting opportunities with problematic provider contracts based on root cause analysis - Interprets Health Net’s Policy and Procedures as it relates to claim issues, providing interpretation and clarification on contracts and benefits - Coordinates with Provider Network Management (PNM) if unable to resolve with provider and internal departments - Participates in process improvement activities working directly with the process improvement team to report root causes and facilitates corrective actions as needed - Prepares monthly reports to management to document issues, action plans, and resolutions of quality initiatives and provider relation improvement initiatives - Researches and responds to Shared Risk Discrepancies from Participating Provider Groups - Performs other duties as assigned - Complies with all policies and standards Education/Experience: Bachelor’s degree in Health Services, Health Care/Hospital Administration, a related field or any combination of education and/or work experience providing equivalent background required. Minimum of two years experience in medical claims review and/or claims appeal required. Pay Range: $56,200.00 - $101,000.00 per year Centene offers a comprehensive benefits package including: competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law, including full-time or part-time status. Total compensation may also include additional forms of incentives. Benefits may be subject to program eligibility. Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law. Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act
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Conflicts & Ethics Specialist
King & SpaldingKing & Spalding is a leading global law firm with a commitment to excellence, innovation, and the seamless delivery of legal services. We harness innovative technology and exceptional talent to meet the complex needs of our clients in a fast-paced and dynamic legal landscape. We are proud of our remarkably cohesive culture, which now encompasses more than 2,500 lawyers and business professionals worldwide. We seek to attract and develop the very best talent to work with us.
King & Spalding is a leading global law firm with a commitment to excellence, innovation, and the seamless delivery of legal services. We harness innovative technology and exceptional talent to meet the complex needs of our clients in a fast-paced and dynamic legal landscape. We are seeking a Conflicts & Ethics Specialist to join our Conflicts & Business Review Department, which is part of the Firm’s General Counsel’s Office. This is an opportunity to join a collaborative team focused on supporting the Firm’s new business intake function. KEY RESPONSIBILITIES: - Conduct comprehensive reviews of new business intake forms, conflict reports, and engagement terms to identify and resolve potential business and ethical conflicts, ensuring full compliance with Firm policies prior to matter initiation. - Draft and review waiver letters, engagement letters, and communicate with lawyers and staff on any changes or additional information that may be necessary before the Firm can accept the new business. - Provide advice to attorneys in connection with conflicts of interest analysis, engagement letters, conflicts waivers, and Firm policies related to new business intake. - Oversee the onboarding of transferring matters for lateral partners. - Work closely with the Associate Director of New Business Intake and a team of Conflicts & Ethics Attorneys. QUALIFICATIONS: - Previous conflicts experience including reviewing conflict reports, researching corporate affiliations, drafting waivers, advising Firm lawyers on conflict or relationship issues and relevant Firm policies, and knowledge of conflicts rules across U.S. and non-U.S. jurisdictions is preferred but not required. - Excellent oral and written communication skills, exceptional critical thinking and problem-solving skills, and a working knowledge of the rules of professional conduct. - Responsive, demonstrate sound judgment, and can work well under pressure. - Ability to adapt to changing priorities, maintain a fast pace, meet deadlines, and manage a heavy workload. - Other duties may be assigned by the Associate Director of New Business Intake or Director of Conflicts & New Business Intake. OTHER: - Primary availability is required during business hours from 9:00 am to 5:30 pm or 11:00 am to 7:30 pm (EST) with flexibility to work outside of this standard schedule as needed. - This position is part of a required periodic on-call rotation. Occasional travel to the Atlanta office may be required. The firm offers a generous total compensation package with bonuses and raises awarded in recognition of individual merit-based performance. All full-time Business Services employees may participate in King & Spalding’s comprehensive benefit program including health and wellness plan, life and disability insurance, flexible spending accounts and a health savings account, a 401(k) plan, profit sharing plan, and a substantial Paid Time Off (PTO) program. Pay Transparency Range: New York, Washington, DC, Chicago, Denver, Sacramento, Los Angeles, San Francisco, Silicon Valley : Full-time annualized salary range $110,000-$135,000. The salary offer will be contingent upon various factors, including but not limited to, relevant experience, internal equity, market data, job location, and other job-related factors permitted by law. Qualified candidates with arrest or conviction records will be considered for employment in accordance with the following laws if applicable: City of Los Angeles’ Fair Chance Initiative for Hiring Ordinance, San Francisco Fair Chance Ordinance, the California Fair Chance Act. King & Spalding LLP (K&S) is committed to providing equal employment opportunity to all applicants and employees in full compliance with all state, federal, and local laws prohibiting discrimination on the basis of race, color, religion, sex, sexual orientation, gender identity, national origin, genetic information, age, disability or any other status protected by applicable law. We are proud of our remarkably cohesive culture, which now encompasses more than 2,500 lawyers and business professionals worldwide. We seek to attract and develop the very best talent to work with us.
Regional Transportation Specialist
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Manage yellow box inventory with 3rd party vendor for proper fulfillment of courier supplies. Other duties as assigned. Physical and Other Requirements: Stooping: Bending body downward and forward by bending spine at the waist. Reaching: Extending hand(s) and arm(s) in any direction. Mobility: The person in this position needs to occasionally move between work sites and inside the office to access file cabinets, office machinery, etc. Communicate: Frequently communicate with others PPE: Biohazard laboratory environment that requires use of personal protective equipment in accordance with CDC and OSHA regulations and company policies. ARUP Policies and Procedures: To conduct self in compliance with all ARUP Policies and Procedures. Medium Work: Exerting up to 50 pounds of force occasionally, and/or up to 30 pounds of force frequently, and/or up to 10 pounds of force constantly to move objects. Fine Motor Control: Picking, pinching, typing or otherwise working, primarily with fingers rather than with the whole hand as in handling. Vision: Having close, far, and peripheral visual acuity to perform a variety of tasks such as make general observations of depth and distance. Climbing: Using hands and feet to pull one's self upward, such as using a ladder. Lifting: Raising objects from a lower to a higher position or moving objects horizontally from position-to-position Vision: Having close, far, and peripheral visual acuity to perform a variety of tasks such as make general observations of depth and distance. Color Vision: Perception of and ability to distinguish colors. Continuing Education: Continual assessment of current literature and best practices. Valid Utah Driver’s License: 1) No moving violations within the previous two years 2) No alcohol/drug-related violations on record with the Driver’s License Division 3) Class D or CDL
Regional Transportation Specialist
ARUP LaboratoriesA national reference laboratory helping clinicians diagnose, monitor, and treat diseases in their patients.
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Coordinate transportation activities within the geographical region assigned, including set up of new routes, edit of existing stops and routes, auditing routes for compliance of set pickup times, ARUP service standards, investigate errors and ensure proper corrective and preventative action, and provide retraining as necessary. Review and reconcile invoices for courier, supply, and air freight services within the assigned region. Look for ways to reduce waste and optimize operational effectiveness and reduce overall transportation costs. Properly use and care for ARUP company equipment used during travel. Understand thoroughly all processes relative to the receiving efforts of incoming shipments to ARUP. Help establish the best method for transportation of incoming shipments. Prioritize shipments, as needed. Represent ARUP and meet client needs quickly, courteously, and efficiently. 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Luxury Destinations Specialist
Affinity TravelsHelping people to fall in travellove and get paid for it
Location: Remote Work from Anywhere in the Caribbean, Latinamerica or US About the Opportunity Do you have a passion for travel, a flair for luxury, and a desire to build a flexible career from anywhere in the world? Were seeking motivated individuals to join our global team as Luxury Destination Specialists, helping clients plan unforgettable outstanding experiences. No prior experience? No problem. We provide full training, mentorship, and access to world-class tools to help you succeed. What You'll Do As a Luxury Destination Specialist, you will: - Use our professional booking platform to curate and sell exclusive travel experiences including hotels, cruises, tours, excursions, events, and concerts and sports events worldwide - Provide personalized recommendations and concierge-level service to clients - Build and manage your own client portfolio - Participate in ongoing training, mentorship, and personal development - Collaborate with a supportive community of travel professionals - Promote exclusive travel offers and earn commissions on bookings What You'll Get - Access to a global booking platform with luxury travel inventory - Comprehensive training and mentorship no experience required - Personal development and business coaching - Supportive team culture - Bonus: Earn a free cruise for two through performance-based incentives - Flexible schedule work remotely from anywhere with Wi-Fi Who Were Looking For - Passionate about travel, luxury, and helping others - Self-motivated and eager to learn - Comfortable working independently and remotely - Strong communication and interpersonal skills - Reliable internet connection and laptop or similar device - Positive attitude and entrepreneurial mindset Ready to Launch Your Travel Career? Don't wait for the perfect moment create it. Apply now to receive full details and begin your journey as a Luxury Destination Specialist. Apply Today and start building your dream career in travel.



