Maintain general ledger accounts and related activities for the production of financial statements and reports Reconcile, analyze and review general ledger accounts in preparation for month end close Prepare journal entries and review accounting classifications, in accordance with generally accepted accounting principles Prepare documentation in support of external and in

Driving and contributing to effective advocacy efforts to advance and protect the Company's objectives at the federal level Actively engaging in lobbying activities by communicating and advocating for priorities and building and deepening the Company's relationships with federal legislative and executive branch officials and staffs Anticipating, influencing and monitoring

Investigate and manage escalated claim/call/appeals issues through root cause analysis and communicate outcome (in person, telephonically or via written communication) Assist with navigating the healthcare system by providing resources for scheduling appt. and assisting with issues related to prolong periods for scheduling appts Assist participants with completing health

Provide skilled nursing care for expectant mothers in the home care environment Travel to provide in home patient care and continuous education to patients and family members Continually assess the mothers' condition to ensure they are safe in the home environment Modify care plans as appropriate based on reassessment, change in prescriber orders, the patient's need for f

Primary focus will be on a Local Market book of business Intricate focus on product integration to maximize company financials Work closely with underwriting and local market sales to derive competitive financial responses Meets quarterly reporting requirements Anticipates customer needs and proactively develops solutions to meet them Serves as a key resource on complex a

Receive assigned provider inquiries and perform a code review on both professional and facility claims Make determinations on cases after a coding review is complete Review various edits on cases and complete audit of medical records received to ensure proper editing is applied Review medical charts electronically Abstract and code diagnosis and procedures from the medica

Primary focus will be on a Local Market book of business Intricate focus on product integration to maximize company financials Work closely with underwriting and local market sales to derive competitive financial responses Meets quarterly reporting requirements Anticipates customer needs and proactively develops solutions to meet them Serves as a key resource on complex a

Addresses the total patient, inclusive of medical, psychosocial, behavioral, cultural, and spiritual needs Involves the individual patient and caregiver, as appropriate, in decision making Facilitates communication and coordination among members of the care team Provides patient care to include patient assessment prior to physician's/nurse practitioner's examination, serv

Make calls to qualified members to provide information and answer questions about health plan programs. Provide "best in class" customer service to enrollees Meet established productivity, schedule adherence, and quality standards while maintaining good attendance. Identify, qualify, and engage members into the most appropriate health and wellness programs to meet their n

Assess, plan, and implement care strategies that are individualized by patient and directed toward the most appropriate, lease restrictive level of care Identify and initiate referrals for social service programs, including financial, psychosocial, community and state supportive services Manage the care plan throughout the continuum of care as a single point of contact Co

Assess, plan, and implement care strategies that are individualized by patient and directed toward the most appropriate, least restrictive level of care Identify and initiate referrals for social service programs, including financial, psychosocial, community and state supportive services Manage the care plan throughout the continuum of care as a single point of contact Co

Perform telephonic customer outreach to improve health quality outcomes in collaboration with clinical pharmacists Provide additional telephonic engagement with providers and pharmacies Assess and interpret customer needs and requirements, triaging to a clinical pharmacist when appropriate Outbound calls to CAHPs detractors and MedAdhmembers to improve member experience a

of Job To effectively and promptly Perform the Administration, build, and troubleshooting for Anaplan models within UHC Workforce Planning & Management, including bugs and enhancements, both in the backend and on the front end (UX) Support multiple different Anaplan models and use cases Understand the differences and similarities between models and assist cross functional

Make outbound calls and receive inbound calls to assess members current health status Identify gaps or barriers in treatment plans Provide patient education to assist with self management Make referrals to outside sources Provide a complete continuum of quality care through close communication with members via in person or on phone interaction Support members with conditi

Handle escalated calls, resolving more complex customer issues Demonstrate outstanding service to identify the source of the caller's issue and work to resolve the inquires in a timely and professional manner Help guide and educate customers about the fundamentals and benefits of consumer driven health care topics such as selecting the best benefit plan options, maximizin