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  • Philadelphia
    Req #1071
    Thursday, October 17, 2019
    General Description: Works under general supervision to collect and process information related to inpatient/ ancillary services and assure that services are authorized for eligible members.   Primary Responsibilities: Process requests for Durable Medical Equipment, transportation, homecare and outpatient rehab services within 2 business days of receiving request.Authorize requests from providers for homecare, infusion, injectables, DME and transportation using approved criteria as per Health Pa ... More
  • Philadelphia
    Req #1080
    Tuesday, October 15, 2019
    Position Summary: Working under general supervision responsible for the resolution of provider claim reconsideration requests, member billing complaints and related issues involving claim adjustment processing via correspondence and/or by telephone.Qualifications:Minimum of three years of claim processing, medical billing, or medical coding experience.Minimum of one year customer service experience.Excellent communication skills; with the ability to write a comprehensive letter of particular imp ... More
  • Philadelphia
    Req #1079
    Tuesday, October 15, 2019
    General Description:   Working under minimal supervision, ensures members with medically/administratively complex needs have access to adequate and appropriate medical care.  Provides case management services, working with members, families, providers, and internal departments to coordinate care within the benefit structure, seeking community resources when needed.  Provides information regarding covered services across the spectrum of care and works to remove barriers to positive health outc ... More
  • Philadelphia
    Req #1078
    Friday, October 11, 2019
    General Description:   Works with minimal supervision to ensure that comprehensive, quality, cost effective patient care is offered for members in need of care coordination.  Review medication profiles, verify appropriate testing, and facilitate office visits with primary care and specialist physicians for members targeted for care coordination services.  Coordinate with hospital case managers to ensure continuity of care and outpatient services when medically appropriate. Coordinate with beh ... More
  • Philadelphia
    Req #1075
    Tuesday, October 8, 2019
    General Description:   Manage, coordinate, and implement a broad range of projects in support of provider reimbursement and accurate claims payments.  Manage day-to-day activities of department managed care reimbursement analysts and specialists.  Ensure the data accuracy and integrity by the establishment of and adherence to best practices within the department.    Primary Responsibilities:   Oversee provider fee schedules for professional, ancillary and hospital providers and develop a ... More
  • Philadelphia
    Req #1049
    Thursday, October 3, 2019
    General Description: Nurse Navigators (NNs) employed by Health Partners Plans (HPP) via funding from the DHS Amendment/Community Based Care Management (CBCM) Program work between practice site care teams including Community Health Workers (CHWs), Community Behavioral Health (CBH) staff and HPP. It is the responsibility of NNs employed via this pilot program to monitor progress and information sharing regarding the Top 10% of HPP members who are eligible for this program.  A key part of this work ... More
  • Philadelphia
    Req #1074
    Wednesday, September 25, 2019
    Summary/Objective:   Lead and direct, across multiple service or business units, the Provider Network team to meet or exceed service requirements and business objectives in multiple lines of business and geographic territories.  Those territories include the entire Commonwealth of Pennsylvania as well as adjacent states.  Primary responsibility is to strategically plan, grow and contract with a comprehensive, quality, high performing, culturally appropriate (language and ethnicity) marketable ... More
  • Philadelphia
    Req #1048
    Monday, September 16, 2019
    Summary/Objective:The Community Based Social Worker (CBSW) is employed by Health Partners Plans (HPP) via funding from the DHS Amendment/Community Based Care Management (CBCM) Program.  The CBSW works with minimal supervision to provide social service resources and linkage to resources for members based at two pediatric sites in keeping with the program goals assigned to the CBCM program.  The CBSW will closely with site staff and the CBCM team to capture data and documentation related to CBCM m ... More
  • Philadelphia
    Req #1060
    Friday, August 9, 2019
    General Description: Working under general supervision of the department head, the Events and Outreach Coordinator is responsible for identifying, planning, coordinating and implementing Medicare Specific marketing events in the community under the direct supervision of the Director of Sales operations. The Events and Outreach Coordinator directly supervises the marketing events and works closely with the Sales and Broker channel Managers, Community Engagement, Events Operations and the sales st ... More
  • Philadelphia
    Req #1059
    Friday, August 9, 2019
    General Description: Working with minimal supervision, the Medicare Advantage Licensed Benefits Advisor is responsible for growing Medicare Advantage enrollment while adhering to all mandates set forth in the CMS marketing and compliance guidelines as well as in the company policies and procedures.  Primary Responsibilities:Identify, educate and enroll Medicare beneficiaries in one of HPP Medicare products Develop and present product presentations to educate and sell the Medicare products to cus ... More
  • Philadelphia
    Req #1053
    Thursday, August 1, 2019
    General Description:Working with minimal supervision, the Medicare Advantage Sales Representative is responsible for growing Medicare Advantage enrollment while adhering to all mandates set forth in the CMS marketing and compliance guidelines as well as in the company policies and procedures.  Primary Responsibilities: Conducting one-on-one sales meetings and house calls as well as work in the field with key providers, local government agencies, community leaders, community based organizations, ... More
  • Philadelphia
    Req #998
    Tuesday, April 30, 2019
    General Description:   Lead all Network Fee for Service provider contracting efforts, including providing support to developing and implementing value-based payment arrangements with key provider partners.   Primary Responsibilities:   Recruits, develops, motivates and retains a high caliber of team members.Coaches and leads team to continuously improve operational performance.Maintains a positive work environment that supports self-direction; provides a structure to optimize experience, ... More
  • Philadelphia
    Req #974
    Thursday, February 21, 2019
    General Description: Respond to participating providers’ incoming calls, and take appropriate action to resolve providers’ issues.  Educate callers about the plan and retain providers using effective customer service techniques to provide a high level of service. Dual role supporting incoming calls from both member’s and providers Primary Responsibilities: Provide accurate and complete information in response to providers’ inquiries, complaints and/or problems.  Collaborate with internal departm ... More
  • Philadelphia
    Req #885
    Tuesday, September 25, 2018
    Position Summary Responsible for the resolution of provider claim reconsideration requests, member billing complaints and related issues involving claim adjustment processing via correspondence, portal requests or projects submitted by providers. Responsibilities Handle and resolve claim inquiries, complaints and appeals received from providers.Adjudicate claim adjustments on line while servicing the provider.Resolve all assigned claim reconsideration requests through MACESS, including completin ... More
  • Philadelphia
    Req #677
    Thursday, November 16, 2017
     Position Summary: Working under general supervision responsible for the resolution of provider claim reconsideration requests, member billing complaints and related issues involving claim adjustment processing via correspondence and/or by telephone.Qualifications:Minimum of three years of claim processing, medical billing, or medical coding experience.Minimum of one year customer service experience.Excellent communication skills; with the ability to write a comprehensive letter of particular im ... More