Obtain accurate and updated patient information, such as name, address, insurance information Perform insurance verification on the date of service Obtain patient signatures for required documents Upload a valid Government issued state ID of patient and patient insurance cards Accurate and complete occupational medicine registration workflow File and maintain medical reco

The Billing Representative is responsible for maintaining patient EMR, including processing physician orders and discharge summaries. In addition, responsible for processing billing information, including verifying accuracy and data entry into the system. Examine workques to ensure that NOA's are generated and transmitted timely through ESolutions for Medicare. Ensure cla

This position supports the Clinical Operations functions and acts as a liaison between members, physicians, delegates, operational business members and member service coordinators. Responsible for providing leadership and guidance to non clinical team and handle escalated issues/problems. Responsibilities Performs review of service requests for completeness of information

This position is responsible for performing LPN duties using established guidelines to ensure appropriate level of care as well as planning for the transition to the continuum of care under the direction/supervision of an RN. Performs duties and types of care management as assigned by management. Responsibilities Performs the following job responsibilities under the direc

Lead and drive the innovative transformation of Horizon's payment landscape to enable better affordability and quality of care while also contributing to improved member and provider experience. This team will be focused on strategic work aimed at better aligning financial incentives and key network partnerships with behaviors that result in high provider network performa

This position will perform care management duties specifically targeting high risk members within commercially risk adjusted populations to enhance the deployment of commercial risk adjustment tactics. This position will work closely with the Risk Adjustment Management (RAM) function, including the RAM Manager & RAM Business Analysts to assess the health status of high ri

This position is responsible for performing RN duties for the Primary Nurse population using established guidelines to ensure appropriate level of care, as well as, planning for the transition to the continuum of care and developing a member centric plan of care. Primary Nurses will outreach to high risk members and will work to engage members in preventative care opportu

Lead the design and implementation of SAP Device Management solutions, ensuring alignment with business objectives. Strategic problem solver who can harmonize technical solutions with business needs, ensuring the delivery of high quality services and solutions to our clients. Collaborate with customers to understand their needs, translating business requirements into tech

This position is responsible for performing RN duties using established guidelines to ensure appropriate level of care as well as planning for the transition to the continuum of care. Performs duties and types of care management as assigned by management. Responsibilities Assesses patient's clinical need against established guidelines and/or standards to ensure that the l

This role demands a strategic thinker who can connect technology solutions with business needs in the Retail, Customer Services, and Utilities domains to drive significant impact Drive the key activities of SAP Service cloud implementations; integrating to backend ISU (S/4HANA) system Present key workshops as defined by the methodology to help gather business requirements

We are seeking a Sr. Functional Architect (Sr. Manager Projects) with 14 17 years of experience, specializing in ISU Intercompany Data Exchange, SAP ISU MPM ISU Master Data Templates, and ISU Process Execution. This role is pivotal in transforming our Utilities, Retail, and Customer Services sectors through innovative architectural solutions. Qualifications Must have a de

Responsible for conducting file audits for all areas of clinical operations. These audits review daily business practice compliance to regulatory compliance relative to NCQA, URAC and CMS. Responsibilities Conduct quarterly file audits for all lines of business against business Process Flows to determine compliance with regulatory standards according to NCQA, URAC and CMS

Lead the design and implementation of SAP FICA solutions, ensuring they meet business requirements and industry standard processes. Collaborate with customers across the organization to define project scopes, goals, and deliverables. Conduct detailed requirement analysis and create functional specifications for SAP FICA Utilities projects. Supervise the integration of SAP

This position is responsible for performing RN duties for the Primary Nurse population using established guidelines to ensure appropriate level of care, as well as, planning for the transition to the continuum of care and developing a member centric plan of care. Primary Nurses will outreach to high risk members and will work to engage members in preventative care opportu

Provide oversight of physician services in the hospice patient care program. Serve as a medical resource to the hospice interdisciplinary group; act as a hospice champion, promoting the program to healthcare professionals, community organizations, and potential donors. Lead and work collaboratively with the interdisciplinary team to ensure continuity of hospice medical se