EMC Business Analyst COMPANY: Emblemhealth LOCATION: 34th Street HOURS: DEPT: Description of Duties Posting Closing Date: 01/08/2010 * Determine and write functional requirements enhancements for hospital, medical and dental EMC systems across EmblemHealth products * Document the function/s of existing systems and write specifications to improve throughput by reducing kick-to-paper and salva

Senior Healthcare Data Analyst COMPANY: Emblemhealth LOCATION: 55 Water St. HOURS: DEPT: Description of Duties Posting Closing Date: 1/08/2010 * Analyzes potential impact of corporate initiatives including HCCI and Medical Group Improvement * Acts as a corporate resources for all data warehouse analytical requests generated from other departments * Provides per member per month trends by ser

Underwriting Compliance Coordinator COMPANY: Emblemhealth LOCATION: 55 Water St. HOURS: DEPT: Description of Duties Closing Posting Date: 01/08/2010 * Underwrites new and existing groups within the published departmental time frames * Communicates Underwriting needs to the Sales Representatives and answers their Underwriting questions * Reviews high-dollar hospital claims for eligibility and

Underwriting Compliance Coordinator COMPANY: Emblemhealth LOCATION: 55 Water St. HOURS: DEPT: Description of Duties Closing Posting Date: 01/08/2010 * Underwrites new and existing groups within the published departmental time frames * Communicates Underwriting needs to the Sales Representatives and answers their Underwriting questions * Reviews high-dollar hospital claims for eligibility and

Medicare Broker Sales Coordinator COMPANY: Emblemhealth LOCATION: 55 Water St. HOURS: DEPT: Description of Duties Posting Closing Date: 01/08/2010 * Supervise the daily operations of Medicare Broker sales, trainings, appointment process and enrollment notifications * Responsible for producer oversight in compliance with CMS regulations for broker sales * Assist FMO?s and Connextions with pro

Lead Clinical Specialist COMPANY: EmblemHealth LOCATION: 55 Water St. HOURS: Mon thru Fri, 9am to 5pm DEPT: Description of Duties Posting closing date: 12/30/2009 Executes varied analytical and program development and supports the daily clinical operations and administration of the department. Manages the economic planning, strategic planning, reporting, disease and case management vendor cont

RN, Supervisor - Concurrent Reviewer Care Management COMPANY: EmblemHealth LOCATION: 55 Water St. HOURS: Mon thru Fri, 9am to 5pm DEPT: Description of Duties Posting closing date: 12/30/2009 This position is responsible for the daily operation, both prospective and concurrent reviews of inpatient and outpatient services, as well as retrospective reviews of homecare. Responsibilities for ensuri

Manager, Complex Specialty Case Management COMPANY: EmblemHealth LOCATION: 55 Water St. HOURS: Mon thru Fri 9am to 5pm DEPT: Description of Duties Posting closing date: 12/30/2009 Responsible for the day to day operation and performance of specific functional areas within the in compliance with HIP Health Plans policies, procedures and all regulatory mandates, consistent with HIP Health Plans

Sr. Contract Specialist COMPANY: Emblemhealth LOCATION: 55 Water St. HOURS: DEPT: Description of Duties Posting Closing Date: 11/19/2009 Establishes and maintains a network of radiology providers to support both commercial and State Sponsored Programs and Network Management?s objectives. Negotiates contracts and maintains network in accordance with NYS requirements and network need. . Supervi

PEP Specialist COMPANY: Emblemhealth LOCATION: 55 Water St. HOURS: DEPT: Description of Duties Posting Closing Date: 12/22/2009 * Provides timely and accurate technical support to the provider community in relation to the use of the Company website and IVR phone system. Supports functions of department as outlined further in Job Success Criteria. Reports higher level problem issues to approp

MEDICARE PHARMACY CASE MANAGER COMPANY: EMBLEMHEALTH LOCATION: 55 Water St. HOURS: Mon to Fri 9:00am to 5:00pm DEPT: Description of Duties Assists in the management of the EmblemHealth Pharmacy Services Compliance Program by ensuring that current practices adhere to State, Federal and other regulatory authorities. * Assist the Pharmacy Compliance Specialist to respond to internal and external

Sr. Revenue Specialist COMPANY: Emblemhealth LOCATION: 55 Water St. HOURS: DEPT: Description of Duties Posting Closing Date: 12/22/2009 * Manages quarterly provider and vendor coding audits to ensure compliance with CMS coding regulations and develops IAP (Internal Action Plans) with those providers and vendors that are not in compliance. This will include supervision of external consultants

Concurrent Reviewer COMPANY: EMBLEMHEALTH LOCATION: 55 Water St. HOURS: Mon to Fri 9:00am to 5:00pm DEPT: Description of Duties Ensures that HIP members are receiving the appropriate level of care in the appropriate setting for the appropriate length of time within the established guidelines and benefit sets. * Assess and evaluates patient?s needs, coordinate goals and discharge plan to be ab

Benefits Administration Specialist COMPANY: EmblemHealth LOCATION: 55 Water St. HOURS: Mon - Fri 9:00am to 5:00pm DEPT: Description of Duties Supports the Director of Benefits Compliance with the Q-care Administrative Adjudication Platform. Provides Q-care benefit consultation and support to HIP staff and external entities, particularly as it relates to the development of base plans, service c

Paralegal COMPANY: EmblemHealth LOCATION: 55 Water St. HOURS: Mon to Fri 9:00am to 5:00pm DEPT: Description of Duties Provides administrative support to the Lead Paralegal and the Legal Department. * Handles potential lawsuits related to claims issues. * Communicates with members who are being sued or have had claims go to collection. * Establishes relationships with law firms regarding coll

Marketing Specialist COMPANY: Emblemhealth LOCATION: 55 Water St. HOURS: DEPT: Description of Duties Closed Posting Date: 12/11/2009 * Work with external agencies to create high-volume, closely timed advertising and direct mail campaigns from concept through response mechanisms * Assist with the creation of advertising and direct mail related to the EmblemHealth brand and Commercial segments

Lead Quality Analyst COMPANY: EmblemHealth LOCATION: Melville (395 N. Service Road) HOURS: DEPT: Description of Duties In this position, you will be responsible for all Quality monthly reporting and adhoc requests. Plan, develop, and implement reports/databases that provide the organization the ability to make decisions. Provide support to the Quality team and other EmblemHealth initiatives b

Senior Healthcare Data Analyst COMPANY: EmblemHealth LOCATION: 55 Water St. HOURS: Mon to Fri 9:00am to 5:00pm DEPT: Description of Duties * Responsible for conducting analyses, projects and statistical studies for GHI at the Corporate line of business and account level. Responsible for assuring that any Corporate data changes are reflected in the data warehouse. Performs other related analys

OCR Analyst COMPANY: Emblemhealth LOCATION: 34th Street HOURS: DEPT: Description of Duties Posting Closing Date: 11/30/2009 * Perform analysis, conduct OCR/Imaging system studies, and recommend changes in methods, procedures and policies to improve quality, workflow and efficiencies with the departments * Assist in implementation of the recommended changes. Follow the process and evaluate th

Retention Specialist (Marketing - Medicare) COMPANY: Emblemhealth LOCATION: 55 Water St. HOURS: DEPT: Description of Duties Posting Closing Date: 11/25/2009 * Assist with application completion and enrollment for initial enrollment or recertification. * Confirm eligibility requirement s have been met prior to initiating enrollment * Inform enrollee of policies, program guidelines and of mana

Provider File Database Analyst COMPANY: Emblemhealth LOCATION: 55 Water St. HOURS: DEPT: Description of Duties Posting Closing Date: 11/25/2009 * Perform ongoing provider file database maintenance, modification and Qcare contract linkages * Conduct all processes related to provider file maintenance to ensure compliance with all applicable regulatory agencies (NCQA, NYS, CMs etc.) * Provide t

Sr. Facility Rates Specialist COMPANY: Emblemhealth LOCATION: 55 Water St. HOURS: DEPT: Description of Duties Posting Closing Date: 11/25/2009 * Loads and updates provider demographics data via CPF on a timely basis * Updates provider contracts with bill types, CPT/HCPCS on a yearly basis or as determined by the provider contract. * Reviews reports generated through Infopak Update the Winstr

COB Customer Service Supervisor COMPANY: Emblemhealth LOCATION: Hollywood Florida HOURS: DEPT: Description of Duties Posting Closing Date: 11/20/2009 * Oversee the workflow of the COB Call Center to ensure compliance with COB contract provisions related to the proper handling and timely processing of incoming telephone calls and correspondence. * Utilize Workforce Management tools to ensure

Director, Operations COMPANY: EmblemHealth LOCATION: 34th Street HOURS: Mon - Fri 9am to 5pm DEPT: Description of Duties Posting closing date: 11/23/2009 Essential Duties: * Establish and maintain standards. Develop policies, procedures and workflows to optimize performance. * Recommends modifications to business processes and/or products to improve service based on customer inquiries and inf

Maternal Health Case Manager COMPANY: EmblemHealth LOCATION: Melville (395 N. Service Road) HOURS: DEPT: Description of Duties In this role, you will provide cost effective, coordinated care for pregnant and recently delivered members who have or are at risk of developing chronic, serious, complex or disabling conditions during pregnancy or after delivery. Requirements Bachelors Degree in

Dental Receptionist COMPANY: EmblemHealth LOCATION: Albany Dental HOURS: DEPT: Description of Duties POSTING EXPIRES 11/13/2009 * Greets patients and visitors and directs them to appropriate locations. * Assists patients in the completion of all required paperwork relating to profiling data, insurance information and financial arrangements. * Maintains and updates patients? files. * Answers

Manager, Hospital Rates COMPANY: Emblemhealth LOCATION: 34th Street HOURS: DEPT: Description of Duties Closing Posting Date: 11/12/2009 * Act as liaison with MIS, Marketing, Legal and other departments on all operating issues related to Hospital Files * Coordinate the implementation of various non-participating fee schedules * Develop files for installation and uploading of various fee sched

Sr. Underwriting Coordinator COMPANY: Emblemhealth LOCATION: 55 Water St. HOURS: DEPT: Description of Duties Closing Posting Date: 11/05/2009 * Updates QCARE promptly and accurately for changes in Benefit Plans, Renewals Rates, and other Group specific data * Processes new accounts into QCARE (includes reviewing of Groups? validity) * Provides support to the Underwriting Department managemen

Specialist, MLTC (Managed Long Term Care) COMPANY: Emblemhealth LOCATION: 55 Water St. HOURS: DEPT: Description of Duties Closing Posting Date: 11/2/2009 * Develop, coordinate, prepare and distribute timely and accurate report submissions required by SDOH, CMS and internal management * Develop and implement program management and contract compliance monitoring tools * Monitor internal operat

Sr. Business Analyst COMPANY: Emblemhealth LOCATION: 55 Water St. HOURS: DEPT: Description of Duties Posting Closing Date: 10/23/2009 * Liaise among stakeholders in order to elicit, analyze, communicate (documents) and validate requirements for changes to business processes and information systems * Facilitate JAD/JAR sessions * Inform and report to the Sr. Director any barriers, issues and

Receiving Supervisor COMPANY: EmblemHealth LOCATION: 34th Street HOURS: Mon to Fri 9:00am to 5:00pm DEPT: Description of Duties * The overall responsibility of this position is to supervise and led the daily operations of Corporate Receiving and Asset tagging processes meet corporate compliance requirements. Develop a high performance and policy driven team of receiving staff which meets and

Sr. Analyst - QA System Configuration COMPANY: Emblemhealth LOCATION: 55 Water St. HOURS: DEPT: Description of Duties Posting Closing Date: 10/14/2009 * Performs in-depth quality analysis and validation of the various master reference files and the processes that use them. (Includes Professional and Facility Contracts, Medical Policies, Preauthorization/Referral files, Benefits configuration

Sr. Analyst - SOX COMPANY: Emblemhealth LOCATION: 55 Water St. HOURS: DEPT: Description of Duties Posting Closing Date: 9/1/2009 * Documents EmblemHealth?s internal controls under Sarbanes Oxley. Designs procedures to test the controls * Tests EmblemHealth?s internal controls under Sarbanes Oxley * Evaluates internal control deficiencies. Proposes remediation to management. Monitors implemen

Supervisor, Health Services Analysis COMPANY: EmblemHealth LOCATION: Melville (395 N. Service Road) HOURS: DEPT: Description of Duties The primary function of the Supervisor, Health Services Analysis is to identify, develop, execute, evaluate, and provide all oversight of quality and process improvement projects in the Quality Management Department. This position will develop and monitor vari

Sr. Project Analyst COMPANY: EmblemHealth LOCATION: 55 Water St. HOURS: Mon to Fri 9:00am to 5:00pm DEPT: Description of Duties posting closing date: 08/14/09 * Manage the SSP revenue initiatives identified by the SSP steering committee. * Provide guidance and assistance to management in identifying business solutions and resulting systems to support SSP Revenue Maximization Initiatives. * Ma

Budget Liaison COMPANY: Emblemhealth LOCATION: 55 Water St. HOURS: DEPT: Description of Duties Closed Posting Date: 6/16/2009 * Support business needs to ensure operating plans and budgets deliver corporate goals and are in line with set parameters. Respond quickly to changing business needs, and collaborate with senior management to drive decisions. * Support Budgeting Process: * Develop a

Sr. Business Analyst, IT Medical Mgmt COMPANY: Emblemhealth LOCATION: 55 Water St. HOURS: DEPT: Description of Duties Posting Closing Date: 4/24/2009 * Applies a broad knowledge of business applications and system software for end-to-end auditing and analysis of key business processes such as UM, DM, CCM, Provider Contracting, Claims, Benefit Administration with a focus on identifying opport