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BlueCross BlueShield of South Carolina
- Birmingham, AL / Atlanta, GA / Burlington, VT / 46 more...
Responsible for completing cost report reopenings within established timeframes and ensuring that the quality of our work meets CMS expectations. Reopenings include review of various provider types and issues related to the Medicare cost report. Description Conducts internal and external timely operational, compliance, and financial audits of divisions, departments, providers, and activities of
Posted 1 day ago
Responsible in the provider enrollment process to review, research, analyze, and process provider enrollment applications. Ensures provider file integrity and that suppliers are in compliance with established standards and guidelines. Description May perform any or all of the following in the enrollment of providers determines the acceptability of provider enrollment applications (which may be u
Posted 1 day ago
Performs medical reviews using clinical/medical information provided by physicians/providers and established criteria/protocol sets or clinical guidelines. Documents decisions using indicated protocol sets or clinical guidelines. Provides support and review of medical claims and utilization practices. Description Performs medical claim reviews for one or more of the following claims for medicall
Posted 1 day ago
Responsible in the provider enrollment process to review, research, analyze, and process provider enrollment applications. Ensures provider file integrity and that suppliers are in compliance with established standards and guidelines. Description May perform any or all of the following in the enrollment of providers determines the acceptability of provider enrollment applications (which may be u
Posted 1 day ago
BlueCross BlueShield of South Carolina
- Springfield, IL / Atlanta, GA / Burlington, VT / 49 more...
Responsible for providing a full range of financial, compliance, and operational audits, business advisory and consultation services, investigations, internal controls, accountability, and use of resources. Description This position is remote. 40% Conducts internal and external timely operational, compliance, and financial audits of divisions, departments, providers, and activities of the corpor
Posted 1 day ago
BlueCross BlueShield of South Carolina
- Springfield, IL / Atlanta, GA / Burlington, VT / 47 more...
Responsible for providing a full range of financial, compliance, and operational audits, business advisory, and consultation services, investigations, internal controls, accountability, and use of resources. Description This position is remote. 50% Conducts internal and/or external timely operational, financial, and/or compliance audits of divisions, departments, providers, and activities of the
Posted 1 day ago
BlueCross BlueShield of South Carolina
- Boise, ID / Atlanta, GA / Burlington, VT / 48 more...
Efficiently oversees all facultative underwriting activities associated with program managers acting on behalf of the company. Responsible for making final underwriting decisions on new and renewal employer stop loss accounts that fall outside of the program manager's level of underwriting authority. Decisions should maximize premium production while minimizing financial risk. Description 60% Re
Posted 1 day ago
As member of the senior management team, provides administrative oversight to the medical staff, analyzes medical review utilization data, researches new medical procedures or technology, and acts as a resource to providers and internal staff on issues concerning medical policies. May also write and revise medical policies. Description This position can be worked remotely. Must be willing to tra
Posted 1 day ago
BlueCross BlueShield of South Carolina
- Charleston, SC / Atlanta, GA / Burlington, VT / 47 more...
Involved in all aspects of the Molecular Diagnostic Program (MoIDX) laboratory operations and serves as an internal subject matter expert, applying medical knowledge to advise decisionmakers in support of MoIDX's mission. Responsible for review and approval of documentation and reports, supporting clinical testing strategies, as well as new assay development and validation. Serves as an ambassador
Posted 1 day ago
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