Jobs with GHI

THIS POSITION IS LOCATED IN THE FLORIDA OFFICE Primary Responsibilities Conduct monthly coaching sessions (includes written summary) with each advocate on his or her team to provide detailed feedbac

The positions will be located at Preferred Health Partners Medical Group in Brooklyn. The office is located in Lindenwood, Brooklyn. Provides case management services for the chronically or at-risk

This position directs and drives the deliverable pertaining to the QA testing of the mainframe claims applications for HMO and PPO business on an enterprise level. The position involves assigning test

Develops and improves quality improvement processes and collaborates with other QI team members to focus and implement plans, practices and programs that improve quality management metrics. Executes

The responsibilities of this position include: Performing audits of quality reviews performed by COB departments and/or Sr. AQ Analysts will include systems processing, telephone evaluations, mail so

Summary: To oversee and manage day-to-day activities involving the Disease Management/Case Management Arrangements/Contracts. This will include implementation of contracts and day to day activities of

THIS POSITION IS LOCATED IN THE HOLLYWOOD, FL OFFICE PRIMARY RESPONSIBILITIES: Initiated and / or respond to telephone inquiries including contractual benefits, benefits eligibility, general request

The positions will be located at Preferred Health Partners Medical Group in Brooklyn. The office is located in Lindenwood, Brooklyn. Case Manager: Achieves optimal benefit and results from the compr

The positions will be located at Preferred Health Partners Medical Group in Brooklyn. The office is located in Lindenwood, Brooklyn. Program Specialist Provides telephonic and in-person health navig

The positions will be located at Preferred Health Partners Medical Group in Brooklyn. The office is located in Lindenwood, Brooklyn. Program Specialist: Provides telephonic and in-person health navi

The Senior Clinical QI Specialist possesses advanced experience and working knowledge of legacy and EmblemHealth systems and has the ability to apply systems experience and knowledge to identify oppor

o Analyzing and resolving problems in electronic file data in all QCare regions (QPN2, QPN3, QPN4, and QPV2) using also the IPA's system, prepare reports and make recommendations for changee. this i

Supports the department's quality of care and cost containment. Provides utilization management as needed to ensure coordination of health care delivery. Conducts medical appropriateness evaluations

Develops customized proposals and presentations in response to bid opportunities, Request for Proposals (RFPs), Requests for Information (RFIs), industry surveys, and other inquiries from customers, c

INTERNAL POSTING CLOSING DATE:1/31/2012. Senior Data Analyst. Responsible for conducting analyses, projects and statistical studies for Emblem at the corporate line of business and account level. R

The Senior Group Practice Specialist will serve as liaison between EmblemHealth and the medical groups with respect to contract administration and practice improvement support. Principal Accountabil

Oversees the strategy, restructuring initiatives and business relationships relating to the relationship between the Company and the traditional medical groups. Supervises Assistant Director and Rela

o Track recovery efforts, potential and recovered dollars, fund transfers, applied credits, on a daily basis for weekly, monthly and quarterly roll-ups. o Prepare and analyze monthly account reconci

Assists in the management of Prepayment Review coding staff responsible for review of the appropriateness of billing and coding of hospital and medical claims to ensure strict compliance with corporat

Organize and lead all external, and selected internal, audits and CMS data validations related to Medicare Advantage and Medicare Part D. This includes those audits conducted by CMS, the Dept of Heal

Summary: Provides confidential secretarial and administrative support to each of the three departments with routine assignments. Essential Duties: Types memos, reports and correspondence Schedules

Provides a professional opinion to the Claims Department regarding authorization. Provides an analytical decision about services rendered according to the department guidelines and members' benefits.

Updates provider contracts with bill types, CPT/HCPCS, ICD9/10 diagnosis and procedure codes and DRG codes on a yearly basis or as determined by the provider contract. Reviews reports generated throug

Supports the department's quality of care and cost containment. Provides utilization management as needed to ensure coordination of health care delivery. Conducts medical appropriateness evaluations

THIS POSITION IS LOCATED IN THE HOLLYWOOD, FL OFFICE Primary Responsibilities: Leads the conducting of Claims Reconciliation file analyses, Provider Reconciliation Research Projects, and developmen