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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. Position Purpose: Plan, organize, monitor, and oversee complex projects utilizing cross functional teams to deliver defined requirements and meet company strategic objectives. Assist in training and perform duties as the Lead Project Manager.<ul> <li>Manage the full project life cycle, including review of various sources to assess requirements, creation of project plans and schedules, obtaining and managing resources, managing budget, and facilitating project execution, deployment and closure</li> <li>Utilize corporate and industry standard project management tools and techniques to effectively manage projects. Assist with establishment and maintenance of corporate project management methodology and other department procedures</li> <li>Maintain detailed project documentation including meeting minutes, action items, issues lists and risk management plans</li> <li>Provide leadership and effectively communicate project status to all stakeholders and external agencies</li> <li>Negotiate with project stakeholders to identify resources, resolve issues, and mitigate risks</li> <li>Coordinate cross-functional meetings with various functional areas to meet overall stakeholder expectations and company’s objectives</li> <li>Provide functional and technical knowledge across multiple business and technical areas.</li> <li>Monitor the creation of all project deliverables to ensure adherence to quality standards including design documents, test plans, training materials, and operations documentation.</li> </ul>Education/Experience:<ul> <li>Bachelor’s degree in related field or equivalent experience.</li> <li>7+ years of project management experience with departmental specific projects.</li> <li>Previous experience as a lead in a functional area, managing cross functional teams on large scale projects or supervisory experience including hiring, training, assigning work and managing the performance of staff.</li> <li>Previous implementation experience strongly preferred.</li> <li>Configuration experience strongly preferred</li> <li>Risk management experience strongly preferred</li> <li>Previous experience with Change Management strongly preferred.</li> <li>Experience with estimating and capacity tracking strongly preferred.</li> <li>Experience with cost management preferred</li> <li>Proficient with MS-Office applications. Healthcare experience; managed care experience preferred.</li> </ul> License/Certification: PMP certification preferred.Pay Range: $86,000.00 - $154,700.00 per yearCentene 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. Total compensation may also include additional forms of incentives.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

Oklahoma Complete Health

Duals Project Manager IV

<h3> Position Summary </h3> As a Small Business Program Manager, you will execute OSBSDP strategies and solutions to support an enterprise-wide approach to small and diverse business utilization. You will address issues or concerns related to small business and diverse business operations, ensuring alignment with stakeholder interests. Your role will involve ensuring compliance with local, governmental, and industrial regulations in all small business and supplier diversity program processes and operations. Additionally, you will support monitoring, reporting, and evaluating the effectiveness of small business and supplier diversity program implementations. You will also support the execution and implementation of strategies for small business and supplier diversity initiatives, addressing market trends and positively supporting firm-wide growth objectives. Recruiting for this role ends on March 10th,2025 Key Responsibilities: Strategic Growth: In the realm of strategic growth, the Small Business Program Manager will host informative meetings with stakeholders, account teams, and sector small business leads to ensure alignment and foster collaboration. The manager will prioritize top accounts in the assigned GPS Sector based on revenue generation and the level of support from the Office of Small Business and Supplier Diversity (OSBSD). They will identify opportunities to leverage SBIR/STTR and Mentor Protégé program benefits, enhancing the strategic growth initiatives of the program. Developing an in-depth understanding of how Federal clients utilize and engage with small and diverse business teaming partners is crucial, as is developing and maintaining a robust network of these partners for the GPS Sectors. The manager will provide advisory support through all stages of the acquisition process, ensuring that the GPS Sector Growth targets for 2030 are met. Efforts will be scaled through collaborations with Sector SB Advocates, Account Teams, and Account and Sector Leaders, ensuring a cohesive and strategic approach to growth. Marketing &amp; Outreach: In the area of Marketing &amp; Outreach, the Small Business Program Manager will manage the award and recognition processes for the assigned GPS Sector, ensuring that achievements are appropriately acknowledged and celebrated. They will work closely with account teams and sectors to create marketing and outreach opportunities that align with strategic goals. By raising visibility with clients, small and diverse business partners, and industry advocacy groups, the manager will enhance the program's profile and impact. Facilitating relationships with key organizations such as the SBA, DCMA, and client OSDBUs is essential to building a strong network of support and collaboration. Additionally, the manager will lead outreach and marketing efforts to meet both strategic and niche requirements, ensuring that the program's initiatives are effectively communicated and promoted. Small Business Utilization: Under Small Business Utilization, the Small Business Program Manager will provide comprehensive guidance on small business strategy, compliance issues, procedures, and best practices to ensure effective and compliant operations. They will connect with industry and agency representatives to interpret client buying trends, allowing for informed decision-making and strategic planning. The manager will introduce innovative small and diverse teaming partners, fostering a dynamic and inclusive network. They will support efforts to reduce barriers to engagement for small and diverse teaming partners, ensuring equitable opportunities and streamlined processes. Additionally, the manager will conduct bi-monthly reviews with account teams to assess progress on small business goals, providing insights and recommendations to drive continuous improvement and success. Compliance and Reporting: Under Compliance and Reporting, the Small Business Program Manager will support mentor protégé performance and ensure compliance with agreements, fostering successful partnerships. They will ensure accurate and timely reporting on sector engagement with small and diverse business requirements, highlighting achievements and areas for improvement. All remarks on ISRs will include references to Deloitte’s performance with small business goal achievement, showcasing the firm's commitment and progress. The manager will collaborate with Business Intelligence for regulatory reporting, ensuring that all data and reports meet necessary standards and requirements. They will support the drafting of small business plans and provide advice on best practices, ensuring that these plans are robust and effective. Additionally, the manager will ensure that all small business subcontracting plans and participation plans are maintained and current, providing a solid foundation for compliance and strategic growth. Professional Conduct: · Demonstrate the highest level of ethics and professional decorum. · Uphold standards of shared vision, empathy, effective communication, and trust. · Support and implement strategies, policies, processes, and procedures developed through the Office of Small Business. · Emphasize proactive customer service, compliance, and business objectives. · Collaborate proactively with GPS teams to maximize impact. · Enable timely, effective, and proactive communications with coach, team members, and GPCO leadership. · Provide timely, responsive and effective status updates and deliverables. Escalate small business challenges early within direct leadership chain. Success Looks Like: General Interactions &amp; Engagements: Success under general interactions and engagements involves maintaining a comprehensive awareness of sector and account activities, ensuring alignment with program goals and strategic direction. It includes collaborating effectively across functions to foster a cohesive and integrated approach. Providing timely project updates and proactively supporting small business pursuits are crucial for maintaining momentum and achieving objectives. Hosting internal and external stakeholder meetings facilitates communication and collaboration, while prioritizing top accounts ensures focused and strategic efforts. Supporting developmental plans for teaming partners and offering advisory support enhances the capabilities and success of these partners. Additionally, supporting GPS Sector Growth and scaling efforts through collaborations with various teams and leaders are key indicators of success, driving overall growth and achievement of strategic targets. <ol><li> Expected Level of Impact: Success in this role involves seeking opportunities for broader awareness of business strategy and goals, ensuring that all actions are aligned with the overarching objectives. It requires challenging existing practices and bringing in innovative solutions to drive continuous improvement. Applying industry and competitor knowledge to build leading practices is essential for maintaining a competitive edge. Modeling effective teaming and integration across teams and business units fosters a collaborative and cohesive work environment. Managing difficult conversations with stakeholders is a critical skill, ensuring that issues are addressed constructively. Active contribution to coaching, project management responsibilities, and team leadership is vital for developing a high-performing team. Anticipating, identifying, and articulating critical business problems allows for proactive problem-solving. Developing solutions to complex problems and leveraging multiple data sources ensures informed decision-making. Managing ambiguity and demonstrating flexibility are key to navigating changing circumstances. Building powerful narratives to influence and collaborate with stakeholders enhances communication and buy-in. Demonstrating understanding and anticipation of team and client needs ensures that actions are relevant and impactful. Finally, integrating and aligning viewpoints of multiple stakeholders ensures that diverse perspectives are considered and unified towards common goals.</li></ol> Qualifications: Required: · Bachelor’s Degree required. · Min. 6+ years of relevant work experience. · Experience and working knowledge of Federal Acquisition Regulations (FAR) and Agency FAR Supplements. · Strong MS Word, MS Excel, MS PowerPoint, data visualization and data analysis skills. · Ability to travel 5-10%, based on work and client needs. · Must be legally authorized to work in the United States without the need for employer sponsorship. Preferred: <ul> <li>Experience supporting Federal and SLHE clients.</li> <li>Advanced degree or relevant certifications.</li> <li>Proficiency with MS Project, and Visio.</li> <li>Strong consultative and communication skills.</li> <li>Command knowledge of Federal Contracting regulations.</li> <li>Ability to operate in a demanding executive-level environment.</li> <li>Demonstrated ability to work effectively and collaboratively with teams.</li> </ul> This role offers a unique opportunity to contribute to the growth and success of small businesses within the public sector, ensuring compliance, fostering innovation, and driving strategic initiatives. CMG Channel may apply and be considered for the role regardless of US office location. The wage range for this role takes into account the wide range of factors that are considered in making compensation decisions including but not limited to skill sets; experience and training; licensure and certifications; and other business and organizational needs. The disclosed range estimate has not been adjusted for the applicable geographic differential associated with the location at which the position may be filled. At Deloitte, it is not typical for an individual to be hired at or near the top of the range for their role and compensation decisions are dependent on the facts and circumstances of each case. A reasonable estimate of the current range is $80,400 - $148,000 You may also be eligible to participate in a discretionary annual incentive program, subject to the rules governing the program, whereby an award, if any, depends on various factors, including, without limitation, individual and organizational performance. Information for applicants with a need for accommodation:<a href="https://www2.deloitte.com/us/en/pages/careers/articles/join-deloitte-assistance-for-disabled-applicants.html" target="_blank">https://www2.deloitte.com/us/en/pages/careers/articles/join-deloitte-assistance-for-disabled-applicants.html</a> EA_ExpHire EA_GPS_ExpHire #LI-KW2 Recruiting tips From developing a stand out resume to putting your best foot forward in the interview, we want you to feel prepared and confident as you explore opportunities at Deloitte. <a href="https://www2.deloitte.com/us/en/pages/careers/topics/recruiting-tips.html" target="_blank">Check out recruiting tips from Deloitte recruiters.</a> Benefits At Deloitte, we know that great people make a great organization. We value our people and offer employees a broad range of benefits. <a href="https://www2.deloitte.com/us/en/pages/careers/articles/life-at-deloitte-benefits-and-rewards.html" target="_blank">Learn more about what working at Deloitte can mean for you.</a> Our people and culture Our diverse, equitable, and inclusive culture empowers our people to be who they are, contribute their unique perspectives, and make a difference individually and collectively. It enables us to leverage different ideas and perspectives, and bring more creativity and innovation to help solve our client most complex challenges. This makes Deloitte one of the most rewarding places to work. <a href="https://www2.deloitte.com/us/en/pages/about-deloitte/articles/deloitte-inclusion.html" target="_blank">Learn more about our inclusive culture.</a> Our purpose Deloitte’s purpose is to make an impact that matters for our clients, our people, and in our communities. We are creating trust and confidence in a more equitable society. At Deloitte, purpose is synonymous with how we work every day. It defines who we are. We are focusing our collective efforts to advance sustainability, equity, and trust that come to life through our core commitments. <a href="https://www2.deloitte.com/us/en/pages/about-deloitte/articles/purpose-at-deloitte-us.html" target="_blank">Learn more about Deloitte's purpose, commitments, and impact.</a> Professional development From entry-level employees to senior leaders, we believe there’s always room to learn. We offer opportunities to build new skills, take on leadership opportunities and connect and grow through mentorship. From on-the-job learning experiences to formal development programs, our professionals have a variety of opportunities to continue to grow throughout their career.

Deloitte

Small Business Program Manager, GPS (Government & Public Services)

You could be the one who changes everything for our 28 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified, national organization offering competitive benefits including a fresh perspective on workplace flexibility. Position Purpose: The Manager of Clinical Pharmacy Operations-Medicare Part D is responsible for developing, implementing and administering clinical pharmacy tools and programs to support corporate and regional drug utilization and financial goals.<ul> <li>Oversees the daily Medicare Part D clinical pharmacy operations including, but not limited to, monitoring of the formulary change process, overseeing the transition fill program, analyzing rejected and paid pharmacy claims, scrutinizing pharmacy claims messaging.</li> <li>Manages, coordinates, monitors and evaluates the activities of the department staff. Oversees the employment, performance evaluation, training, motivation and counseling of assigned associates.</li> <li>Ensures HNPS’ compliance with Formulary Administration and Transition Fill Program requirements in addition to all CMS requirements relative to Medicare Part D.</li> <li>Provides clinical and operations support for planning, creating, maintaining and reviewing HN Medicare Part D Formularies, Prior Authorization criteria, Step Therapy criteria and other utilization management restrictions.</li> <li>Ensure timely and accurate submission of all HPMS formulary files, PA files, ST criteria and negative formulary changes.</li> <li>Oversees the QA process for maintaining accurate HN Medicare Part D formularies in the Formulary and Benefit system.</li> <li>Acts as a clinical liaison between HNPS and CMS and the pharmacy claims processor.</li> <li>Leads efforts and participates in the development and maintenance of new programs required by CMS.</li> <li>Creates/revises policies and procedures pertaining to Health Net, Inc. Medicare Part D program</li> </ul>Education/Experience: Pharm D or equivalent experience in Pharmacy. 4 years' experience working within a pharmacy or related health care environment required. 3 years management experience required. Medicare Part D operations with emphasis on formulary management, preferred. License/Certification: Maintain current, valid and unrestricted Pharmacist License.Job Specific Details:<ul> <li>Participating in Zoom/Webex/MS Teams meetings to support routine operational responsibilities in addition to key projects involving Medicare formularies.</li> <li>Providing support to direct reports to execute on key tasks related to maintenance of business or special projects.</li> <li>Analyzing new Medicare guidance or PBM alerts to determine if any formulary support is needed.</li> <li>Collaborate with other team members to address any formulary issues or inquiries submitted to the team from other areas of the business.</li> </ul>Pay Range: $105,600.00 - $195,400.00 per yearCentene 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. Total compensation may also include additional forms of incentives.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

Manager, Clinical Pharmacy Operations (Medicare Part D)

At CVS Health, we’re building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care.As the nation’s leading health solutions company, we reach millions of Americans through our local presence, digital channels and more than 300,000 purpose-driven colleagues – caring for people where, when and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it all with heart, each and every day.Position Summary The Enrollment Representative position will be supporting multiple health plans. Under general supervision, verifies enrollment status, makes changes to member/client records, and addresses a variety of enrollment questions or concerns. Maintains enrollment databases and coordinates transfer of non-electronic eligibility data. • Responds, researches, and resolves eligibility and/or billing related issues involving member specific information; •Works directly with clients, field marketing offices and/or local claim operations to achieve positive service outcomes.(*) • Monitors daily status reports assessing output for developing trends potentially impacting service levels. (*) • Applies all appropriate considerations associated with technical requirements, legislative/regulatory policies, account structure and benefit parameters in addressing eligibility matters. (*) • Validates benefit plan enrollment information for assigned clients for accuracy and completeness; coordinates the distribution of membership ID cards and partnering with appropriate internal/external support areas involving any requests for ID card customization. (*) • Completes screen coding and data entry requirements related to the systems processes impacting the generation and release of member-specific and plan sponsor products (e.g., ID cards, change applications, audit lists, in-force lists, HIPAA certificates and various reports). (*) • Completes data entry requirements for finalizing new enrollment information as well as for changes and/or terminations. (*) • When necessary, reviews and corrects transaction errors impacting eligibility interfaces and prepares eligibility/enrollment information for imaging. (*) • Interprets and translates client benefits and supporting account structure against internal systems/applications(i.e.,GEBAR, AAS, and CCI). (*) • Determines and communicates standard service charges to internal/external customers related to paper eligibility activities; May include negotiating and communicating charges pertaining to non-standard services. • Partners with other team functions to coordinate the release of eligibility and benefit plan information; reproduces group bills if requested by clients. Required Qualifications <ul> <li>Attention to detail and accuracy.</li> <li>Problem solving skills.</li> <li>Strong organization skills.</li> <li>Understands the impact of work to other teams and downstream support areas.</li> <li>Ability to analyze and research data to make appropriate corrections as necessary.</li> <li>Strong verbal and written communication skills.</li> <li>Workplace flexibility - ability to adapt to change.</li> <li>Required to maintain work schedule within EST time zone (9:30am- 6:00pm EST).</li> <li>Ability to remain available for overtime, with possible weekend work where needed.</li> </ul> Preferred Qualifications <ul> <li>Knowledge of Health Care and/or MCO’s.</li> <li>Knowledge of Enrollment.</li> <li>Knowledge Medicaid and/or Medicare.</li> <li>Knowledge and comfortability with learning different systems and using Excel (VLOOKUP).</li> </ul> Education <ul><li>High School Diploma or equivalent.</li></ul> Anticipated Weekly Hours40Time TypeFull timePay RangeThe typical pay range for this role is:$17.00 - $28.46This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.Great benefits for great peopleWe take pride in our comprehensive and competitive mix of pay and benefits – investing in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In addition to our competitive wages, our great benefits include:<ul> <li>Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan.</li> <li>No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching.</li> <li>Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility.</li> </ul>For more information, visit <a href="https://jobs.cvshealth.com/us/en/benefits" target="_blank">https://jobs.cvshealth.com/us/en/benefits</a>We anticipate the application window for this opening will close on: 03/29/2025Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.

CVSHealth

Eligibility Consultant

At CVS Health, we’re building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care.As the nation’s leading health solutions company, we reach millions of Americans through our local presence, digital channels and more than 300,000 purpose-driven colleagues – caring for people where, when and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it all with heart, each and every day.Position SummaryResponsible for managing to resolution appeal scenarios for all products, which contain multiple issues and may require coordination of responses from multiple business units. Appeals are typically more complex and may require outreach and deviation from standard processes to complete. Act as a subject matter expert by providing training, coaching, or responding to complex issues. May have contact with outside plan sponsors or regulators.• Research and resolves incoming electronic appeals as appropriate as a “single-point-of-contact” based on type of appeal.• Can identify and reroute inappropriate work items that do not meet complaint/appeal criteria as well as identify trends in misrouted work.• Assemble all data used in making denial determinations and can act as subject matter expert with regards to unit workflows, fiduciary responsibility and appeals processes and procedures.• Research standard plan design, certification of coverage and potential contractual deviations to determine the accuracy and appropriateness of a benefit/administrative denial.• Can review a clinical determination and understand rationale for decision.• Able to research claim processing logic and various systems to verify accuracy of claim payment, member eligibility data, billing/payment status, and prior to initiation of the appeal process.• Serves as point person for newer staff in answering questions associated with claims/customer service systems and products. Educates team mates as well as other areas on all components within member or provider/practitioner complaints/appeals for all products and services.• Coordinates efforts both internally and across departments to successfully resolve claims research, SPD/COC interpretation, letter content, state or federal regulatory language, triaging of complaint/appeal issues, and similar situations requiring a higher level of expertise.• Identifies trends and emerging issues and reports on and gives input on potential solutions.• Delivers internal quality reviews, provides appropriate support in third party audits, customer meetings, regulatory meetings and consultant meetings when required.• Understands and can respond to Executive complaints and appeals, Department of Insurance, Department of Health or Attorney General complaints or appeals on behalf of members or providers as assigned.Required Qualifications :- 1-2 years Medicare part C Appeals experience.- 1 years experience in reading or researching benefit language in SPDs or COCs.- 1 years of experience in research and analysis of claim processing.- Demonstrated ability to handle multiple assignments competently, accurately and efficiently.- Excellent verbal and written communication skills.- Computer navigation ability and ability to multitask.- Excellent customer service skills.- Strong Leadership skills- Experience documenting workflows and reengineering efforts. Preferred Qualifications - Project management skills are preferred.- Strong knowledge of all case types including all specialty case types Education - High School DiplomaAnticipated Weekly Hours40Time TypeFull timePay RangeThe typical pay range for this role is:$18.50 - $35.29This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above. Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.Great benefits for great peopleWe take pride in our comprehensive and competitive mix of pay and benefits – investing in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In addition to our competitive wages, our great benefits include:<ul> <li>Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan.</li> <li>No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching.</li> <li>Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility.</li> </ul>For more information, visit <a href="https://jobs.cvshealth.com/us/en/benefits" target="_blank">https://jobs.cvshealth.com/us/en/benefits</a>We anticipate the application window for this opening will close on: 04/02/2025Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.

Senior Coordinator Complaint Appeals Operations - Fully Remote

<h3> Position Summary </h3> Are you an experienced, passionate pioneer in technology who wants to work in a collaborative environment? As an experienced Epic Certified Professional Billing Expected Reimbursement Contracts Specialist you will have the ability to share new ideas and collaborate on projects as a consultant without the extensive demands of travel. If so, consider an opportunity with Deloitte under our Project Delivery Talent Model. Project Delivery Model (PDM) is a talent model that is tailored specifically for long-term, onsite client service delivery. Work you’ll do/Responsibilities <ul> <li>As a Consultant at Deloitte Consulting, you will be responsible for individually contributing to your work / mentor junior team members along with liaising with onsite/offshore teams to understand the functional requirements.</li> <li>Working on Billing and Contracts Reimbursement configuration and builds by maintaining industry and client standards ensuring build quality and timeline adherence as well as debugging and resolving any issues/defects.</li> <li>Participate in the daily calls / scrum meetings with respect to deliverables and build the weekly status reports to be reviewed with leadership. </li> <li>Resolve issues or incidents reported by end users and escalate any quality issues or risks with team leads/scrum masters/project leaders. </li> <li>This position has responsibility within all phases of patient access application support and optimization including design, build, test, and maintenance of the application</li> <li>This role provides outstanding client service and contributes to the organization’s mission of utilizing information technology to improve patient care</li> <li>Troubleshoot problems and address questions from users and provide on-call support on a rotating basis.</li> <li>Make recommendations, review and test changes, enhancements, and each new release as assigned.</li> <li>Communicate regularly with Engagement Managers (Directors), project team members, and representatives from various functional and / or technical teams, including escalating any matters that require additional attention and consideration from engagement management</li> </ul> The Team Our Core Technology Operations (CTO) team offers differentiated operate services for our clients with solutions to help organizations scale and optimize critical business operations, drive speed to outcome, deliver business transformation, and build resilience in an uncertain future. Qualifications Required <ul> <li>Epic Certification: Must possess current Epic Professional Billing Expected Reimbursement Contracts certification</li> <li>5+ years of experience in IT systems administration, with at least 2 years specifically working with Epic systems.</li> <li>Prior experience working in the Healthcare Industry</li> <li>Bachelor's degree, preferably in Computer Science, Information Technology, Computer Engineering, or related IT discipline; or equivalent experience</li> <li>Limited immigration sponsorship may be available</li> <li>Remote work with the ability to travel 10%, on average, based on the work you do and the clients and industries/sectors you serve. Also, provide on-call support on a rotating basis.</li> </ul> Preferred <ul> <li>Epic Certification: Current Epic Resolute Professional Billing/Epic Resolute Hospital Billing certification</li> <li>Previous Consulting experience</li> <li>Analytical/ decision making responsibilities</li> <li>Analytical ability to manage multiple projects and prioritize tasks into manageable work products</li> <li>Can operate independently or with minimum supervision</li> <li>Excellent written and communication skills</li> <li>Ability to deliver technical demonstrations</li> </ul> Information for applicants with a need for accommodation: <a href="https://www2.deloitte.com/us/en/pages/careers/articles/join-deloitte-assistance-for-disabled-applicants.html" target="_blank">https://www2.deloitte.com/us/en/pages/careers/articles/join-deloitte-assistance-for-disabled-applicants.html</a> Recruiting tips From developing a stand out resume to putting your best foot forward in the interview, we want you to feel prepared and confident as you explore opportunities at Deloitte. <a href="https://www2.deloitte.com/us/en/pages/careers/topics/recruiting-tips.html" target="_blank">Check out recruiting tips from Deloitte recruiters.</a> Benefits At Deloitte, we know that great people make a great organization. We value our people and offer employees a broad range of benefits. <a href="https://www2.deloitte.com/us/en/pages/careers/articles/life-at-deloitte-benefits-and-rewards-usdc.html" target="_blank">Learn more about what working at Deloitte can mean for you.</a> Our people and culture Our inclusive culture empowers our people to be who they are, contribute their unique perspectives, and make a difference individually and collectively. It enables us to leverage different ideas and perspectives, and bring more creativity and innovation to help solve our client most complex challenges. This makes Deloitte one of the most rewarding places to work. Our purpose Deloitte’s purpose is to make an impact that matters for our clients, our people, and in our communities. We are creating trust and confidence in a more equitable society. At Deloitte, purpose is synonymous with how we work every day. It defines who we are. We are focusing our collective efforts to advance sustainability, equity, and trust that come to life through our core commitments. <a href="https://www2.deloitte.com/us/en/pages/about-deloitte/articles/purpose-at-deloitte-us.html" target="_blank">Learn more about Deloitte's purpose, commitments, and impact.</a> Professional development From entry-level employees to senior leaders, we believe there’s always room to learn. We offer opportunities to build new skills, take on leadership opportunities and connect and grow through mentorship. From on-the-job learning experiences to formal development programs, our professionals have a variety of opportunities to continue to grow throughout their career.

Epic Certified Professional Billing Expected Reimbursement Contracts Specialist

<h3> Position Summary </h3> Are you an experienced, passionate pioneer in technology who wants to work in a collaborative environment? As an experienced Epic Certified Hospital Billing Expected Reimbursement Contracts Specialist you will have the ability to share new ideas and collaborate on projects as a consultant without the extensive demands of travel. If so, consider an opportunity with Deloitte under our Project Delivery Talent Model. Project Delivery Model (PDM) is a talent model that is tailored specifically for long-term, onsite client service delivery. Work you’ll do/Responsibilities <ul> <li>As a Consultant at Deloitte Consulting, you will be responsible for individually contributing to your work / mentor junior team members along with liaising with onsite/offshore teams to understand the functional requirements.</li> <li>Working on Billing and Contracts Reimbursement configuration and builds by maintaining industry and client standards ensuring build quality and timeline adherence as well as debugging and resolving any issues/defects.</li> <li>Participate in the daily calls / scrum meetings with respect to deliverables and build the weekly status reports to be reviewed with leadership. </li> <li>Resolve issues or incidents reported by end users and escalate any quality issues or risks with team leads/scrum masters/project leaders. </li> <li>This position has responsibility within all phases of patient access application support and optimization including design, build, test, and maintenance of the application</li> <li>This role provides outstanding client service and contributes to the organization’s mission of utilizing information technology to improve patient care</li> <li>Troubleshoot problems and address questions from users and provide on-call support on a rotating basis.</li> <li>Make recommendations, review and test changes, enhancements, and each new release as assigned.</li> <li>Communicate regularly with Engagement Managers (Directors), project team members, and representatives from various functional and / or technical teams, including escalating any matters that require additional attention and consideration from engagement management</li> </ul> The Team Our Core Technology Operations (CTO) team offers differentiated operate services for our clients with solutions to help organizations scale and optimize critical business operations, drive speed to outcome, deliver business transformation, and build resilience in an uncertain future. Qualifications Required <ul> <li>Epic Certification: Must possess current Epic Hospital Billing Expected Reimbursement Contracts certification.</li> <li>5+ years of experience in IT systems administration, with at least 2 years specifically working with Epic systems.</li> <li>Prior experience working in the Healthcare Industry</li> <li>Bachelor's degree, preferably in Computer Science, Information Technology, Computer Engineering, or related IT discipline; or equivalent experience</li> <li>Limited immigration sponsorship may be available</li> <li>Remote work with the ability to travel 10%, on average, based on the work you do and the clients and industries/sectors you serve. Also, provide on-call support on a rotating basis.</li> </ul> Preferred <ul> <li>Epic Certification: Current Epic Resolute Professional Billing/Epic Resolute Hospital Billing certification</li> <li>Previous Consulting experience</li> <li>Analytical/ decision making responsibilities</li> <li>Analytical ability to manage multiple projects and prioritize tasks into manageable work products</li> <li>Can operate independently or with minimum supervision</li> <li>Excellent written and communication skills</li> <li>Ability to deliver technical demonstrations</li> </ul> Information for applicants with a need for accommodation: <a href="https://www2.deloitte.com/us/en/pages/careers/articles/join-deloitte-assistance-for-disabled-applicants.html" target="_blank">https://www2.deloitte.com/us/en/pages/careers/articles/join-deloitte-assistance-for-disabled-applicants.html</a> Recruiting tips From developing a stand out resume to putting your best foot forward in the interview, we want you to feel prepared and confident as you explore opportunities at Deloitte. <a href="https://www2.deloitte.com/us/en/pages/careers/topics/recruiting-tips.html" target="_blank">Check out recruiting tips from Deloitte recruiters.</a> Benefits At Deloitte, we know that great people make a great organization. We value our people and offer employees a broad range of benefits. <a href="https://www2.deloitte.com/us/en/pages/careers/articles/life-at-deloitte-benefits-and-rewards-usdc.html" target="_blank">Learn more about what working at Deloitte can mean for you.</a> Our people and culture Our inclusive culture empowers our people to be who they are, contribute their unique perspectives, and make a difference individually and collectively. It enables us to leverage different ideas and perspectives, and bring more creativity and innovation to help solve our client most complex challenges. This makes Deloitte one of the most rewarding places to work. Our purpose Deloitte’s purpose is to make an impact that matters for our clients, our people, and in our communities. We are creating trust and confidence in a more equitable society. At Deloitte, purpose is synonymous with how we work every day. It defines who we are. We are focusing our collective efforts to advance sustainability, equity, and trust that come to life through our core commitments. <a href="https://www2.deloitte.com/us/en/pages/about-deloitte/articles/purpose-at-deloitte-us.html" target="_blank">Learn more about Deloitte's purpose, commitments, and impact.</a> Professional development From entry-level employees to senior leaders, we believe there’s always room to learn. We offer opportunities to build new skills, take on leadership opportunities and connect and grow through mentorship. From on-the-job learning experiences to formal development programs, our professionals have a variety of opportunities to continue to grow throughout their career.

Epic Certified Hospital Billing Expected Reimbursement Contracts Specialist

<h2>DESCRIPTION</h2> Screening Services creates a safe and trustworthy workplace for all Amazonians by delivering pre and in-employment background checks. Amazon is the fastest growing large employer in the world, and we need to deliver screening services at the fastest rate, with the highest quality, and with the maximum flexibility – a unique business problem that no other company in the world is facing. The diversity of workers at Amazon is unprecedented, and this is creating a need for a new service. As HR Specialist, you will be required to handle existing and future pipeline programs to deliver quality customer service to Amazon's many diverse businesses. You will interact with a fast-moving customers, and your challenge will be to execute a complex operation with compliance, quality, and speed so that customer engagements can move forward. You will require data-driven judgment, and be able to earn trust with your customers. Core responsibilities: · Initiate background checks with vendors and ensure checks are fulfilled within SLA. · Adjudicate background checks, particularly in complex scenarios requiring high judgement. This includes research and documentation in alignment with regulatory guidance. · Produce operational reports · Support and document screening requirements and processes for customer accounts The successful candidate will have a demonstrated track record of: · Executing a complex operation requiring attention to detail and high judgment. · Demonstrating a bias for action and an ability to deal with great ambiguity. · Agility and ability to adapt quickly to changing requirements and demands · Successful project delivery, particularly in deploying new processes and process improvements. · Documenting business requirements and specifications, working cross-functionally with customers, legal, service teams, technology, and vendors. <h2>BASIC QUALIFICATIONS</h2> - 3+ years of human resources experience - Experience with HR processes and systems <h2>PREFERRED QUALIFICATIONS</h2> - Experience with process improvement and stakeholder management - Experience managing confidential and sensitive employee information and adherence to strict confidentiality standards Amazon is committed to a diverse and inclusive workplace. Amazon is an equal opportunity employer and does not discriminate on the basis of race, national origin, gender, gender identity, sexual orientation, protected veteran status, disability, age, or other legally protected status. Our inclusive culture empowers Amazonians to deliver the best results for our customers. If you have a disability and need a workplace accommodation or adjustment during the application and hiring process, including support for the interview or onboarding process, please visit <a href="https://amazon.jobs/content/en/how-we-hire/accommodations" target="_blank">https://amazon.jobs/content/en/how-we-hire/accommodations</a> for more information. If the country/region you’re applying in isn’t listed, please contact your Recruiting Partner. Our compensation reflects the cost of labor across several US geographic markets. The base pay for this position ranges from $47,500/year in our lowest geographic market up to $94,000/year in our highest geographic market. Pay is based on a number of factors including market location and may vary depending on job-related knowledge, skills, and experience. Amazon is a total compensation company. Dependent on the position offered, equity, sign-on payments, and other forms of compensation may be provided as part of a total compensation package, in addition to a full range of medical, financial, and/or other benefits. For more information, please visit <a href="https://www.aboutamazon.com/workplace/employee-benefits" target="_blank">https://www.aboutamazon.com/workplace/employee-benefits</a>. This position will remain posted until filled. Applicants should apply via our internal or external career site.

Amazon

HR Specialist, Screening, BGC & DT Operations

Sr Business Analyst, Business Planning Analyst - Capital One Shopping (Remote-Eligible)This is your opportunity to join Capital One's fast-growing consumer app. Within Capital One, the Shopping team is working on a new consumer product that seeks to change the way people buy things online. Our mission is to deliver a best-in-class shopping and savings experience for our millions of customers while driving incremental and sustainable sales for our merchant partners.The Strategic Planning team is looking to hire a Business Planning Analyst, who will play a crucial role in shaping our growth trajectory. This is an exciting opportunity to contribute to our success by focusing on strategic hiring planning and optimizing capital allocation in a fast paced environment. You will serve as a key partner to leadership and delivery teams, providing insights and support to achieve our ambitious goals.To be successful in the role, you will need to be a well-rounded 'business athlete’ - a creative, analytical, and technically proficient problem solver who understands both the dynamics of the business and the tech landscape. The ideal candidate is resourceful, motivated, and self-sufficient, with demonstrated success in spearheading cross-functional projects that drive the growth and success of a business.General Responsibilities: <ul> <li>Develop and maintain comprehensive investment plans aligning with business objectives and growth projections</li> <li>Build business cases and conduct analysis to assess the potential and performance and of R&amp;D investments</li> <li>Create and manage financial models to forecast product level revenue and ROI metrics</li> <li>Work closely with Sales, Growth, and Product teams to understand and influence revenue impacts from operational strategies</li> <li>Partner with talent acquisition and department leaders to ensure effective execution of growth plans and delivery goals</li> <li>Establish and track key performance indicators (KPIs) to monitor team progress and delivery against commitments</li> <li>Develop and maintain reporting dashboards to provide real-time visibility into portfolio performance</li> <li>Work closely with colleagues across Capital One including: IT, Sales, Operations, Finance and others to drive improvement in quality, volume, service, and profitability </li> <li>A proven track record of decision making and problem solving based on analytics</li> <li>Strong business judgment, leadership and integrity: He/she should be a tenacious decision maker, able to bring a healthy, aggressive, yet responsible approach to business </li> <li>Solid people leadership experience: Ability to build and leverage the capabilities of a high-performing team, as well as business partners across the enterprise. He/she should foster innovation, drive critical decisions, hold business partners accountable, and be able to consistently deliver results </li> <li>Strong executive communication skills: Impeccable written and oral communication credentials, coupled with strategic influencing skills and the ability to drive agreement through intellect, interpersonal and negotiation skills </li> <li>Clear results orientation: display an intense focus on achieving both short and long term goals. He/she should be able to drive and execute an agenda in an uncertain and fluid environment </li> <li>Successful track record of thriving in a fast paced, entrepreneurial and dynamic environment. Previous consulting experience is a plus </li> </ul>Capital One is open to hiring a Remote Employee for this opportunity.Basic Qualifications:<ul> <li>Bachelor’s Degree in any quantitative field (Business, Math, Economics, Finance, Statistics, Science, Engineering)</li> <li>At least 1 year of experience in analysis</li> <li>At least 1 year of experience in SQL querying</li> </ul>Preferred Qualifications:<ul> <li>Master’s Degree in Business or quantitative field such as Finance, Economics, Physical Sciences, Math, Statistics, Engineering</li> <li>1+ years of experience in Statistical model building</li> <li>1+ years of experience in market research</li> <li>2+ years of experience in SQL querying</li> <li>2+ years of experience in business analysis</li> <li>1+ years of experience in consulting</li> </ul>Capital One will consider sponsoring a new qualified applicant for employment authorization for this position.The minimum and maximum full-time annual salaries for this role are listed below, by location. Please note that this salary information is solely for candidates hired to perform work within one of these locations, and refers to the amount Capital One is willing to pay at the time of this posting. Salaries for part-time roles will be prorated based upon the agreed upon number of hours to be regularly worked.New York, NY: $118,900 - $135,700 for Sr. Business Analyst Remote (Regardless of Location): $99,100 - $113,100 for Sr. Business Analyst McLean, VA: $109,000 - $124,400 for Sr. Business Analyst Candidates hired to work in other locations will be subject to the pay range associated with that location, and the actual annualized salary amount offered to any candidate at the time of hire will be reflected solely in the candidate’s offer letter.This role is also eligible to earn performance based incentive compensation, which may include cash bonus(es) and/or long term incentives (LTI). Incentives could be discretionary or non discretionary depending on the plan.Capital One offers a comprehensive, competitive, and inclusive set of health, financial and other benefits that support your total well-being. Learn more at the <a href="https://www.capitalonecareers.com/benefits" target="_blank">Capital One Careers website</a>. Eligibility varies based on full or part-time status, exempt or non-exempt status, and management level.This role is expected to accept applications for a minimum of 5 business days.No agencies please. Capital One is an equal opportunity employer committed to diversity and inclusion in the workplace. All qualified applicants will receive consideration for employment without regard to sex (including pregnancy, childbirth or related medical conditions), race, color, age, national origin, religion, disability, genetic information, marital status, sexual orientation, gender identity, gender reassignment, citizenship, immigration status, protected veteran status, or any other basis prohibited under applicable federal, state or local law. Capital One promotes a drug-free workplace. Capital One will consider for employment qualified applicants with a criminal history in a manner consistent with the requirements of applicable laws regarding criminal background inquiries, including, to the extent applicable, Article 23-A of the New York Correction Law; San Francisco, California Police Code Article 49, Sections 4901-4920; New York City’s Fair Chance Act; Philadelphia’s Fair Criminal Records Screening Act; and other applicable federal, state, and local laws and regulations regarding criminal background inquiries.If you have visited our website in search of information on employment opportunities or to apply for a position, and you require an accommodation, please contact Capital One Recruiting at 1-800-304-9102 or via email at <a href="#">RecruitingAccommodation@capitalone.com</a>. All information you provide will be kept confidential and will be used only to the extent required to provide needed reasonable accommodations.For technical support or questions about Capital One's recruiting process, please send an email to <a href="#">Careers@capitalone.com</a>Capital One does not provide, endorse nor guarantee and is not liable for third-party products, services, educational tools or other information available through this site.Capital One Financial is made up of several different entities. Please note that any position posted in Canada is for Capital One Canada, any position posted in the United Kingdom is for Capital One Europe and any position posted in the Philippines is for Capital One Philippines Service Corp. (COPSSC).

Capital One

Sr Business Analyst, Business Planning Analyst - Capital One Shopping (Remote-Eligible)

At CVS Health, we’re building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care.As the nation’s leading health solutions company, we reach millions of Americans through our local presence, digital channels and more than 300,000 purpose-driven colleagues – caring for people where, when and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it all with heart, each and every day.Position SummaryAetna, a CVS Health company has an outstanding opportunity for a Medical Director. Ready to take your career to the next level with a Fortune 6 company? This is a remote Work at Home position and can be located anywhere in the United States. In this role as Medical Director MPO (Medical Policy &amp; Operations) you will be responsible for providing clinical expertise and business direction in support of medical management programs to promote the delivery of high quality, constituent focused medical care with a focus on clinical and payment policy. This Medical Director provides subject matter expertise to provide clinical support and business direction in these areas. Knowledge of Aetna clinical and coding policy and experience with appeals, claim review, reimbursement issues, and coding is preferable, but a willingness to learn is essential. The Primary Responsibilities of the Medical Director include support of the appeal process, clinical claim review process, pre-certification, and predetermination of covered benefits in the Commercial and Medicare environment. This Medical Director provides subject matter expertise in clinical and payment policy to provide clinical support and business direction in these areas. In this role you will: ◾Participate on work groups as a clinical subject matter expert to identify and promote opportunities to improve the quality and efficiency of health care services. ◾Apply clinical coding and reimbursement expertise to ensure alignment and correct application of Aetna policies and practices to service and payment requests.◾Proactively use data analysis to identify opportunities for quality improvement and positively influence the effective delivery of quality care services. ◾ Be a subject matter expert and internal consultant and payment policy contributor subject matter expertise and internal consultant. ◾Demonstrate the ability to work within and lead as necessary teams comprised of a diverse group of health delivery professionals in order to manage the business objectives of the company. ◾Work Collaboratively with the functional areas. Required Qualifications*Five (5) or more years of experience in Health Care Delivery System e.g., Clinical Practice and Health Care Industry. *Active and current state medical license without encumbrances. *M.D. or D.O., Board Certification in an ABMS recognized specialty including post-graduate direct patient care experience Preferred Qualifications* Health plan/payor experience. * Foundational baseline skills in Medicine, Health Policy, Coding: HCPCS / CPT, Clinical Policy, Reimbursement and Health Care Systems. * Strong communication skills both written and verbal. Education* M.D. or D.O., Board Certification in an ABMS recognized specialty including post-graduate direct patient care experiencePay RangeThe typical pay range for this role is:$174,070.00 - $374,920.00 This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above. This position also includes an award target in the company’s equity award program. Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.Great benefits for great peopleWe take pride in our comprehensive and competitive mix of pay and benefits – investing in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In addition to our competitive wages, our great benefits include:<ul> <li>Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan.</li> <li>No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching.</li> <li>Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility.</li> </ul>For more information, visit <a href="https://jobs.cvshealth.com/us/en/benefits" target="_blank">https://jobs.cvshealth.com/us/en/benefits</a>We anticipate the application window for this opening will close on: 04/30/2025Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.

12 Operations Jobs in Harrisburg, PA, USA