Employer Industry: Healthcare Services
Why Consider This Job Opportunity
- Salary up to $105,000 annually
- Comprehensive benefits package including equity stock purchase and 401k contributions
- Opportunity for career advancement and growth within the organization
- Work remotely from anywhere within the U.S.
- Supportive and inclusive work environment focused on health optimization
- Recognition programs to reward performance and achievements
What To Expect (Job Responsibilities)
- Conduct monthly regulatory reporting to Health Plans using internal data sources and external programs
- Perform comprehensive research and analysis to evaluate compliance with network adequacy requirements
- Assist with internal and on-site audits of provider payments
- Respond to and complete audit requests from Payors and Regulatory bodies
- Collaborate with Care Delivery Organizations (CDO) to resolve operational issues
What Is Required (Qualifications)
- 4+ years of experience in the managed care industry, preferably in network management, auditing, or contracting
- 1+ years of experience performing network adequacy analysis and knowledge of CMS, DCHS, and DMHC requirements
- 1+ years of experience with contracting applications such as Salesforce and Contract Manager
- High proficiency with Microsoft Excel, Word, and Access
- Ability to work PST hours
How To Stand Out (Preferred Qualifications)
- Medical coding experience
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