Specialist jobs at Presbyterian

Shift: Days (United States of America) Scheduled Weekly Hours: 40 Worker Type: Regular Exemption Status: Yes For over a century, Geisinger has been dedicated to caring for our communities-not just through exceptional healthcare, but by fostering meaningful connections and treating every individual with dignity and respect. Now, we're inviting passionate radiologists to join our dynamic Cardiothoracic/Body/Abdominal Imaging team. As part of our team of 80+ radiologists and advanced practitioners, you'll thrive in an academic environment that supports teaching and mentorship of residents, fellows, and medical students. Whether you prefer working remotely or onsite, you'll enjoy a collaborative culture, cutting-edge technology, and a favorable call schedule. Job Duties: Join a team of 20 radiologists across the Geisinger system Practice all aspects of Abdominal Imaging: MR, CT, Ultrasound, and GI Fluoroscopic studies Access to state-of-the-art imaging tools including 3T MRI and TeraRecon thin client Dedicated 3D Lab & 3D Printing capabilities Participate in multidisciplinary conferences Work in a diverse and inclusive environment Position Details: Competitive compensation and incentive package Comprehensive benefits starting day one: medical, dental, vision, and pharmacy Generous time off: PTO, holidays, CME time and allowance Retirement plans: 401(k), Roth TSA-403(b), 457(b) Paid malpractice insurance with tail coverage Full relocation assistance for qualified candidates #NCHN Education: Doctor of Medicine or Doctor of Osteopathic Medicine- (Required) Experience: Certification(s) and License(s): Licensed Medical Doctor - State of Pennsylvania Skills: Patient Care And Procedural Skills, Professional Etiquette, Systems-Based Practice OUR PURPOSE & VALUES: Everything we do is about caring for our patients, our members, our students, our Geisinger family and our communities. KINDNESS: We strive to treat everyone as we would hope to be treated ourselves. EXCELLENCE: We treasure colleagues who humbly strive for excellence. LEARNING: We share our knowledge with the best and brightest to better prepare the caregivers for tomorrow. INNOVATION: We constantly seek new and better ways to care for our patients, our members, our community, and the nation. SAFETY: We provide a safe environment for our patients and members and the Geisinger family. We offer healthcare benefits for full time and part time positions from day one, including vision, dental and domestic partners. Perhaps just as important, we encourage an atmosphere of collaboration, cooperation and collegiality. We know that a diverse workforce with unique experiences and backgrounds makes our team stronger. Our patients, members and community come from a wide variety of backgrounds, and it takes a diverse workforce to make better health easier for all. We are proud to be an affirmative action, equal opportunity employer and all qualified applicants will receive consideration for employment regardless to race, color, religion, sex, sexual orientation, gender identity, national origin, disability or status as a protected veteran.

Molina Health Plan Provider Network Contracting jobs are responsible for the network strategy and development with respect to adequacy, financial performance and operational performance, in alignment with Molina Healthcare's overall mission, core values, and strategic plan and in compliance with all relevant federal, state and local regulations. Responsible for accurate and timely maintenance of critical provider information on all claims and provider databases. Synchronizes data among multiple claims systems when available, and the application of business rules as they apply to each database. Validate data to be housed on provider databases and ensure adherence to business and system requirements of customers as it pertains to contracting, network management and credentialing. **Job Duties** This role supports negotiations with assigned contracts and letters of agreements with non-complex provider community that result in high quality, cost effective and marketable providers. Maintains tracking system and publish reports according to departmental procedures. - Sends out contracts/applications to prospective providers upon request of Director or Manager and/or Provider Contracting and/or Provider Relations team members. - Receives calls from prospective providers and answers questions regarding contracting process, policies and procedures. - Forwards requested information/documentation to prospective providers in a timely manner. - Maintains database of all contracts and specific applications sent to prospective new providers. - Completes and updates Provider Information Forms for each new contract. - Ensures accuracy and completeness of provider demographic information and coordinates communication of such information to Provider Configuration team. - Sends out new provider welcome packets to providers who have contracted with the plan. - Utilizes Plan's system to track and follow up with Providers who have not responded to Contracts and/or Applications sent as directed by management. - Formats and distributes Provider network resources (e.g. electronic specialist directory). **Job Qualifications** **REQUIRED EDUCATION** : High School Diploma or equivalent GED **REQUIRED EXPERIENCE/KNOWLEDGE, SKILLS & ABILITIES** : 1 year customer service, provider service, contracting or claims experience in the healthcare industry. **PREFERRED EDUCATION** : Associate's Degree or Bachelor's Degree in a related field or an equivalent combination of education and experience **PREFERRED EXPERIENCE** : Managed Care experience To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V. Pay Range: $21.16 - $42.2 / HOURLY *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

Molina Health Plan Provider Network Contracting jobs are responsible for the network strategy and development with respect to adequacy, financial performance and operational performance, in alignment with Molina Healthcare's overall mission, core values, and strategic plan and in compliance with all relevant federal, state and local regulations. Responsible for accurate and timely maintenance of critical provider information on all claims and provider databases. Synchronizes data among multiple claims systems when available, and the application of business rules as they apply to each database. Validate data to be housed on provider databases and ensure adherence to business and system requirements of customers as it pertains to contracting, network management and credentialing. Job Duties This role supports negotiations with assigned contracts and letters of agreements with non-complex provider community that result in high quality, cost effective and marketable providers. Maintains tracking system and publish reports according to departmental procedures. * Sends out contracts/applications to prospective providers upon request of Director or Manager and/or Provider Contracting and/or Provider Relations team members. * Receives calls from prospective providers and answers questions regarding contracting process, policies and procedures. * Forwards requested information/documentation to prospective providers in a timely manner. * Maintains database of all contracts and specific applications sent to prospective new providers. * Completes and updates Provider Information Forms for each new contract. * Ensures accuracy and completeness of provider demographic information and coordinates communication of such information to Provider Configuration team. * Sends out new provider welcome packets to providers who have contracted with the plan. * Utilizes Plan's system to track and follow up with Providers who have not responded to Contracts and/or Applications sent as directed by management. * Formats and distributes Provider network resources (e.g. electronic specialist directory). Job Qualifications REQUIRED EDUCATION: High School Diploma or equivalent GED REQUIRED EXPERIENCE/KNOWLEDGE, SKILLS & ABILITIES: 1 year customer service, provider service, contracting or claims experience in the healthcare industry. PREFERRED EDUCATION: Associate's Degree or Bachelor's Degree in a related field or an equivalent combination of education and experience PREFERRED EXPERIENCE: Managed Care experience To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V. Pay Range: $21.16 - $42.2 / HOURLY * Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. About Us Molina Healthcare is a nationwide fortune 500 organization with a mission to provide quality healthcare to people receiving government assistance. If you are seeking a meaningful opportunity in a team-oriented environment, come be a part of a highly engaged workforce dedicated to our mission. Bring your passion and talents and together we can make a difference in the lives of others. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.

Molina Health Plan Provider Network Contracting jobs are responsible for the network strategy and development with respect to adequacy, financial performance and operational performance, in alignment with Molina Healthcare's overall mission, core values, and strategic plan and in compliance with all relevant federal, state and local regulations. Responsible for accurate and timely maintenance of critical provider information on all claims and provider databases. Synchronizes data among multiple claims systems when available, and the application of business rules as they apply to each database. Validate data to be housed on provider databases and ensure adherence to business and system requirements of customers as it pertains to contracting, network management and credentialing. **Job Duties** This role supports negotiations with assigned contracts and letters of agreements with non-complex provider community that result in high quality, cost effective and marketable providers. Maintains tracking system and publish reports according to departmental procedures. - Sends out contracts/applications to prospective providers upon request of Director or Manager and/or Provider Contracting and/or Provider Relations team members. - Receives calls from prospective providers and answers questions regarding contracting process, policies and procedures. - Forwards requested information/documentation to prospective providers in a timely manner. - Maintains database of all contracts and specific applications sent to prospective new providers. - Completes and updates Provider Information Forms for each new contract. - Ensures accuracy and completeness of provider demographic information and coordinates communication of such information to Provider Configuration team. - Sends out new provider welcome packets to providers who have contracted with the plan. - Utilizes Plan's system to track and follow up with Providers who have not responded to Contracts and/or Applications sent as directed by management. - Formats and distributes Provider network resources (e.g. electronic specialist directory). **Job Qualifications** **REQUIRED EDUCATION** : High School Diploma or equivalent GED **REQUIRED EXPERIENCE/KNOWLEDGE, SKILLS & ABILITIES** : 1 year customer service, provider service, contracting or claims experience in the healthcare industry. **PREFERRED EDUCATION** : Associate's Degree or Bachelor's Degree in a related field or an equivalent combination of education and experience **PREFERRED EXPERIENCE** : Managed Care experience To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V. Pay Range: $21.16 - $42.2 / HOURLY *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

Molina Health Plan Provider Network Contracting jobs are responsible for the network strategy and development with respect to adequacy, financial performance and operational performance, in alignment with Molina Healthcare's overall mission, core values, and strategic plan and in compliance with all relevant federal, state and local regulations. Responsible for accurate and timely maintenance of critical provider information on all claims and provider databases. Synchronizes data among multiple claims systems when available, and the application of business rules as they apply to each database. Validate data to be housed on provider databases and ensure adherence to business and system requirements of customers as it pertains to contracting, network management and credentialing. Job Duties This role supports negotiations with assigned contracts and letters of agreements with non-complex provider community that result in high quality, cost effective and marketable providers. Maintains tracking system and publish reports according to departmental procedures. * Sends out contracts/applications to prospective providers upon request of Director or Manager and/or Provider Contracting and/or Provider Relations team members. * Receives calls from prospective providers and answers questions regarding contracting process, policies and procedures. * Forwards requested information/documentation to prospective providers in a timely manner. * Maintains database of all contracts and specific applications sent to prospective new providers. * Completes and updates Provider Information Forms for each new contract. * Ensures accuracy and completeness of provider demographic information and coordinates communication of such information to Provider Configuration team. * Sends out new provider welcome packets to providers who have contracted with the plan. * Utilizes Plan's system to track and follow up with Providers who have not responded to Contracts and/or Applications sent as directed by management. * Formats and distributes Provider network resources (e.g. electronic specialist directory). Job Qualifications REQUIRED EDUCATION: High School Diploma or equivalent GED REQUIRED EXPERIENCE/KNOWLEDGE, SKILLS & ABILITIES: 1 year customer service, provider service, contracting or claims experience in the healthcare industry. PREFERRED EDUCATION: Associate's Degree or Bachelor's Degree in a related field or an equivalent combination of education and experience PREFERRED EXPERIENCE: Managed Care experience To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V. Pay Range: $21.16 - $42.2 / HOURLY * Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. About Us Molina Healthcare is a nationwide fortune 500 organization with a mission to provide quality healthcare to people receiving government assistance. If you are seeking a meaningful opportunity in a team-oriented environment, come be a part of a highly engaged workforce dedicated to our mission. Bring your passion and talents and together we can make a difference in the lives of others. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.

Work From HomeWork From Home Work From Home, Indiana 46544The Coder VI Specialist- Hospital Inpatient analyzes the ICD 10 codes, suggested by computer assisted coding software, to ensure they align with official coding guidelines and the electronic medical record documentation. In collaboration with the Clinical Documentation Specialist, analyzes the circumstances of the visit to determine the most accurate diagnosis related group (DRG). This position also abstracts key data elements necessary for billing and data analysis. WHO WE ARE With 12 ministries and access points across Indiana and Illinois, Franciscan Health is one of the largest Catholic health care systems in the Midwest. Franciscan Health takes pride in hiring coworkers that provide compassionate, comprehensive care for our patients and the communities we serve. WHAT YOU CAN EXPECT Accurately reviews and codes patient records in the following clinical areas: hospital inpatient services. Reviews and analyzes the content of medical records and the autosuggested computer assisted codes (CAC) for the appropriate assignment of ICD diagnosis/procedure codes, present on admission indicators, hierarchical condition categories, complication and comorbidities in the proper sequence in accordance with official coding resources resulting in an accurate DRG assignment. Auditing the accuracy of the CAC software autosuggested codes. Reviews clinical documentation to validate accurate representation of the patient's clinical picture, treatment, and diagnoses. Identifies when documentation relevant to the coding process is missing, lacks specificity or is inconsistent and take steps to obtain the documentation. Identifies and enters data elements for abstracting. Meets defined coding accuracy standards. Meets defined coding productivity standards. Basic understanding of how natural language processing engine works. Applies broad guidelines to specific coding situations, independently utilizing discretion and a significant level of analytic ability. Understands how diagnosis and procedure codes, and reimbursement methodologies are used to determine reimbursement, public reporting of outcomes, quality of patient care, financial modeling, strategic planning, and marketing. Remains current with coding and industry changes through participation in educational opportunities to maintain coding credentials. Demonstrates a thorough knowledge of hospital inpatient coding guidelines, medical terminology, anatomy/physiology, and payer specific coding guidelines. Notifies coding leadership of trends and topics for education and feedback to physicians and departments. Assists with identification and implementation of process improvements, according to industry best practice standards, to make the best use of resources, decrease costs and improve coding services across the specialized service lines. Abides by the Standards of Ethical Coding as set forth by the American Health Information Management Association/American Association of Procedural Coders and adheres to official coding guidelines. Qualifications Required High School Diploma/GED Preferred Associate's Degree Health Information Management Preferred Bachelor's Degree Health Information Management 2 years Coding Required Certified Coding Specialist (CCS) - American Health Information Management Association (AHIMA) Registered Health Information Technician (RHIT) - American Health Information Management Association (AHIMA) Registered Health Information Administrator (RHIA) - American Health Information Management Association (AHIMA) TRAVEL IS REQUIRED: Never or RarelyJOB RANGE:Coder VI Specialist - Hospital Inpatient $22.70-$33.77INCENTIVE: EQUAL OPPORTUNITY EMPLOYER It is the policy of Franciscan Alliance to provide equal employment to its employees and qualified applicants for employment as otherwise required by an applicable local, state or Federal law. Franciscan Alliance reserves a Right of Conscience objection in the event local, state or Federal ordinances that violate its values and the free exercise of its religious rights. Franciscan Alliance is committed to equal employment opportunity. Franciscan provides eligible employees with comprehensive benefit offerings. Find an overview on the benefit section of our career site, jobs.franciscanhealth.org.

Molina Health Plan Provider Network Contracting jobs are responsible for the network strategy and development with respect to adequacy, financial performance and operational performance, in alignment with Molina Healthcare's overall mission, core values, and strategic plan and in compliance with all relevant federal, state and local regulations. Responsible for accurate and timely maintenance of critical provider information on all claims and provider databases. Synchronizes data among multiple claims systems when available, and the application of business rules as they apply to each database. Validate data to be housed on provider databases and ensure adherence to business and system requirements of customers as it pertains to contracting, network management and credentialing. Job Duties This role supports negotiations with assigned contracts and letters of agreements with non-complex provider community that result in high quality, cost effective and marketable providers. Maintains tracking system and publish reports according to departmental procedures. * Sends out contracts/applications to prospective providers upon request of Director or Manager and/or Provider Contracting and/or Provider Relations team members. * Receives calls from prospective providers and answers questions regarding contracting process, policies and procedures. * Forwards requested information/documentation to prospective providers in a timely manner. * Maintains database of all contracts and specific applications sent to prospective new providers. * Completes and updates Provider Information Forms for each new contract. * Ensures accuracy and completeness of provider demographic information and coordinates communication of such information to Provider Configuration team. * Sends out new provider welcome packets to providers who have contracted with the plan. * Utilizes Plan's system to track and follow up with Providers who have not responded to Contracts and/or Applications sent as directed by management. * Formats and distributes Provider network resources (e.g. electronic specialist directory). Job Qualifications REQUIRED EDUCATION: High School Diploma or equivalent GED REQUIRED EXPERIENCE/KNOWLEDGE, SKILLS & ABILITIES: 1 year customer service, provider service, contracting or claims experience in the healthcare industry. PREFERRED EDUCATION: Associate's Degree or Bachelor's Degree in a related field or an equivalent combination of education and experience PREFERRED EXPERIENCE: Managed Care experience To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V. Pay Range: $21.16 - $42.2 / HOURLY * Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. About Us Molina Healthcare is a nationwide fortune 500 organization with a mission to provide quality healthcare to people receiving government assistance. If you are seeking a meaningful opportunity in a team-oriented environment, come be a part of a highly engaged workforce dedicated to our mission. Bring your passion and talents and together we can make a difference in the lives of others. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.

Molina Health Plan Provider Network Contracting jobs are responsible for the network strategy and development with respect to adequacy, financial performance and operational performance, in alignment with Molina Healthcare's overall mission, core values, and strategic plan and in compliance with all relevant federal, state and local regulations. Responsible for accurate and timely maintenance of critical provider information on all claims and provider databases. Synchronizes data among multiple claims systems when available, and the application of business rules as they apply to each database. Validate data to be housed on provider databases and ensure adherence to business and system requirements of customers as it pertains to contracting, network management and credentialing. Job Duties This role supports negotiations with assigned contracts and letters of agreements with non-complex provider community that result in high quality, cost effective and marketable providers. Maintains tracking system and publish reports according to departmental procedures. * Sends out contracts/applications to prospective providers upon request of Director or Manager and/or Provider Contracting and/or Provider Relations team members. * Receives calls from prospective providers and answers questions regarding contracting process, policies and procedures. * Forwards requested information/documentation to prospective providers in a timely manner. * Maintains database of all contracts and specific applications sent to prospective new providers. * Completes and updates Provider Information Forms for each new contract. * Ensures accuracy and completeness of provider demographic information and coordinates communication of such information to Provider Configuration team. * Sends out new provider welcome packets to providers who have contracted with the plan. * Utilizes Plan's system to track and follow up with Providers who have not responded to Contracts and/or Applications sent as directed by management. * Formats and distributes Provider network resources (e.g. electronic specialist directory). Job Qualifications REQUIRED EDUCATION: High School Diploma or equivalent GED REQUIRED EXPERIENCE/KNOWLEDGE, SKILLS & ABILITIES: 1 year customer service, provider service, contracting or claims experience in the healthcare industry. PREFERRED EDUCATION: Associate's Degree or Bachelor's Degree in a related field or an equivalent combination of education and experience PREFERRED EXPERIENCE: Managed Care experience To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V. Pay Range: $21.16 - $42.2 / HOURLY * Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. About Us Molina Healthcare is a nationwide fortune 500 organization with a mission to provide quality healthcare to people receiving government assistance. If you are seeking a meaningful opportunity in a team-oriented environment, come be a part of a highly engaged workforce dedicated to our mission. Bring your passion and talents and together we can make a difference in the lives of others. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.

Molina Health Plan Provider Network Contracting jobs are responsible for the network strategy and development with respect to adequacy, financial performance and operational performance, in alignment with Molina Healthcare's overall mission, core values, and strategic plan and in compliance with all relevant federal, state and local regulations. Responsible for accurate and timely maintenance of critical provider information on all claims and provider databases. Synchronizes data among multiple claims systems when available, and the application of business rules as they apply to each database. Validate data to be housed on provider databases and ensure adherence to business and system requirements of customers as it pertains to contracting, network management and credentialing. Job Duties This role supports negotiations with assigned contracts and letters of agreements with non-complex provider community that result in high quality, cost effective and marketable providers. Maintains tracking system and publish reports according to departmental procedures. * Sends out contracts/applications to prospective providers upon request of Director or Manager and/or Provider Contracting and/or Provider Relations team members. * Receives calls from prospective providers and answers questions regarding contracting process, policies and procedures. * Forwards requested information/documentation to prospective providers in a timely manner. * Maintains database of all contracts and specific applications sent to prospective new providers. * Completes and updates Provider Information Forms for each new contract. * Ensures accuracy and completeness of provider demographic information and coordinates communication of such information to Provider Configuration team. * Sends out new provider welcome packets to providers who have contracted with the plan. * Utilizes Plan's system to track and follow up with Providers who have not responded to Contracts and/or Applications sent as directed by management. * Formats and distributes Provider network resources (e.g. electronic specialist directory). Job Qualifications REQUIRED EDUCATION: High School Diploma or equivalent GED REQUIRED EXPERIENCE/KNOWLEDGE, SKILLS & ABILITIES: 1 year customer service, provider service, contracting or claims experience in the healthcare industry. PREFERRED EDUCATION: Associate's Degree or Bachelor's Degree in a related field or an equivalent combination of education and experience PREFERRED EXPERIENCE: Managed Care experience To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V. Pay Range: $21.16 - $42.2 / HOURLY * Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. About Us Molina Healthcare is a nationwide fortune 500 organization with a mission to provide quality healthcare to people receiving government assistance. If you are seeking a meaningful opportunity in a team-oriented environment, come be a part of a highly engaged workforce dedicated to our mission. Bring your passion and talents and together we can make a difference in the lives of others. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.

Work From HomeWork From Home Work From Home, Indiana 46544 The People Analytics Specialist helps develop and deploy analytic and reporting solutions at Franciscan Health. They serve as a data steward and coordinates aspects of HR analytics and usage to support reporting and analytics for Human Resources. The position plays an important role within the People Analytics team, providing support to a key business area and/or a center of excellence within the Human Resources organization. This is a highly skilled, high impact team with deep operational and technical expertise which leverages healthcare and organizational analytics to solve real-world problems. They partner with stakeholders and other analytics leaders to understand, prioritize and resource HR analytic needs. The People Analytics Specialist will be knowledgeable in the use People Analytics, Manager Insights, Learning Analytics, and Workforce Planning analytics. This includes creating and maintaining datasets via Workday Prism and assisting with report and dashboard development in the application. WHO WE ARE With 12 ministries and access points across Indiana and Illinois, Franciscan Health is one of the largest Catholic health care systems in the Midwest. Franciscan Health takes pride in hiring coworkers that provide compassionate, comprehensive care for our patients and the communities we serve. WHAT YOU CAN EXPECT Understanding, shaping, and defining reporting and analytics needs and requests. Develop and maintain databases, data systems, and data reports, ensuring accuracy and confidentiality of information. Assist in creating strategic workforce plans by providing data-based insights into recruitment, engagement, retention, and performance. Identify trends, patterns, and anomalies in the data, and provide a clear interpretation of the findings. Create and present reports that effectively communicate trends and predictions in employee behavior and needs. Work closely with HR and management to develop and implement data-driven strategies for workforce optimization. Perform reporting needs assessment. QUALIFICATIONS Bachelor's Degree Human Resource, Business or related field - Required Work Experience in Workday or other similar Enterprise Resource Program - Required 1 year of relevant professional experience in Human Resources with concentration in Data Analytics - Preferred Workday Pro Certification - Preferred TRAVEL IS REQUIRED: Never or RarelyJOB RANGE:People Analytics Specialist $71,094.40 - $97,760.00INCENTIVE:Not Applicable EQUAL OPPORTUNITY EMPLOYER It is the policy of Franciscan Alliance to provide equal employment to its employees and qualified applicants for employment as otherwise required by an applicable local, state or Federal law. Franciscan Alliance reserves a Right of Conscience objection in the event local, state or Federal ordinances that violate its values and the free exercise of its religious rights. Franciscan Alliance is committed to equal employment opportunity. Franciscan provides eligible employees with comprehensive benefit offerings. Find an overview on the benefit section of our career site, jobs.franciscanhealth.org.

Provides support for CA Medi-Cal and Marketplace benefits and services including reviewing and resolving member appeals and complaints, then communicating resolution to members or authorized representatives in accordance with the standards and requirements established by the CA Department of Managed Health Care (DMHC) and CA Department of Health Care Services (DHCS) **Essential Job Duties** - Facilitates comprehensive research and resolution of appeals, disputes, grievances, and/or complaints from Molina members, providers, and related outside agencies to ensure that internal and/or regulatory timelines are met. - Researches claims appeals and grievances using support systems to determine appropriate appeals and grievance outcomes. - Requests and reviews medical records, notes, and/or detailed bills as appropriate; formulates conclusions per protocol and other business partners to determine response; assures timeliness and appropriateness of responses per state, federal and Molina guidelines. - Meets claims production standards set by the department. - Applies contract language, benefits and review of covered services to claims review process. - Contacts members/providers as needed via written and verbal communications. - Prepares appeal summaries and correspondence, and documents findings accordingly (includes information on trends as requested). - Composes all correspondence, appeals/disputes and/or grievances information concisely, accurately and in accordance with regulatory requirements. - Researches claims processing guidelines, provider contracts, fee schedules and systems configurations, to determine root causes of payment errors. - Resolves and prepares written response to incoming provider reconsideration requests related to claims payment, requests for claim adjustments, and/or requests from outside agencies. **Required Qualifications** - At least 2 years of managed care experience in a call center, appeals, and/or claims environment, or equivalent combination of relevant education and experience. - Health claims processing experience, including coordination of benefits (COB), subrogation and eligibility criteria. - Experience with Medicaid and Medicare claims denials and appeals processing, and knowledge of regulatory guidelines for appeals and denials. - Customer service experience. - Strong organizational and time management skills; ability to manage simultaneous projects and tasks to meet internal deadlines. - Effective verbal and written communication skills. - Microsoft Office suite/applicable software program(s) proficiency. **Preferred Qualifications** - Customer/provider experience in a managed care organization (Medicaid, Medicare, Marketplace and/or other government-sponsored program), or medical office/hospital setting. - Completion of a health care related vocational program in health care (i.e., certified coder, billing, or medical assistant). To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V. Pay Range: $21.16 - $38.37 / HOURLY *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

Responsible for reviewing and resolving member and provider complaints and communicating resolution to members and provider (or authorized representatives) in accordance with the standards and requirements established by the Centers for Medicare and Medicaid KNOWLEDGE/SKILLS/ABILITIES * Responsible for the comprehensive research and resolution of the appeals, dispute, grievances, and/or complaints from Molina members, providers and related outside agencies to ensure that internal and/or regulatory timelines are met. * Research claims appeals and grievances using support systems to determine appeal and grievance outcomes. * Requests and reviews medical records, notes, and/or detailed bills as appropriate; formulates conclusions per protocol and other business partners to determine response; assures timeliness and appropriateness of responses per state, federal and Molina Healthcare guidelines. * Responsible for meeting production standards set by the department. * Apply contract language, benefits, and review of covered services * Responsible for contacting the member/provider through written and verbal communication. * Prepares appeal summaries, correspondence, and document findings. Include information on trends if requested. * Composes all correspondence and appeal/dispute and or grievances information concisely and accurately, in accordance with regulatory requirements. * Research claims processing guidelines, provider contracts, fee schedules and system configurations to determine root cause of payment error. * Resolves and prepares written response to incoming provider reconsideration request is relating to claims payment and requests for claim adjustments or to requests from outside agencies JOB QUALIFICATIONS REQUIRED EDUCATION: High School Diploma or equivalency REQUIRED EXPERIENCE: * Min. 2 years operational managed care experience (call center, appeals or claims environment). * Health claims processing background, including coordination of benefits, subrogation, and eligibility criteria. * Familiarity with Medicaid and Medicare claims denials and appeals processing, and knowledge of regulatory guidelines for appeals and denials. * Strong verbal and written communication skills To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V. Pay Range: $21.16 - $38.37 / HOURLY * Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. About Us Molina Healthcare is a nationwide fortune 500 organization with a mission to provide quality healthcare to people receiving government assistance. If you are seeking a meaningful opportunity in a team-oriented environment, come be a part of a highly engaged workforce dedicated to our mission. Bring your passion and talents and together we can make a difference in the lives of others. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.

Responsible for reviewing and resolving member and provider complaints and communicating resolution to members and provider (or authorized representatives) in accordance with the standards and requirements established by the Centers for Medicare and Medicaid **KNOWLEDGE/SKILLS/ABILITIES** + Responsible for the comprehensive research and resolution of the appeals, dispute, grievances, and/or complaints from Molina members, providers and related outside agencies to ensure that internal and/or regulatory timelines are met. + Research claims appeals and grievances using support systems to determine appeal and grievance outcomes. + Requests and reviews medical records, notes, and/or detailed bills as appropriate; formulates conclusions per protocol and other business partners to determine response; assures timeliness and appropriateness of responses per state, federal and Molina Healthcare guidelines. + Responsible for meeting production standards set by the department. + Apply contract language, benefits, and review of covered services + Responsible for contacting the member/provider through written and verbal communication. + Prepares appeal summaries, correspondence, and document findings. Include information on trends if requested. + Composes all correspondence and appeal/dispute and or grievances information concisely and accurately, in accordance with regulatory requirements. + Research claims processing guidelines, provider contracts, fee schedules and system configurations to determine root cause of payment error. + Resolves and prepares written response to incoming provider reconsideration request is relating to claims payment and requests for claim adjustments or to requests from outside agencies **JOB QUALIFICATIONS** **REQU** **I** **RED ED** **U** **C** **A** **TI** **O** **N** **:** High School Diploma or equivalency **REQU** **I** **RED E** **X** **PE** **R** **I** **E** **N** **C** **E:** + Min. 2 years operational managed care experience (call center, appeals or claims environment). + Health claims processing background, including coordination of benefits, subrogation, and eligibility criteria. + Familiarity with Medicaid and Medicare claims denials and appeals processing, and knowledge of regulatory guidelines for appeals and denials. + Strong verbal and written communication skills To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V. Pay Range: $21.16 - $38.37 / HOURLY *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

Provides support for CA Medi-Cal and Marketplace benefits and services including reviewing and resolving member appeals and complaints, then communicating resolution to members or authorized representatives in accordance with the standards and requirements established by the CA Department of Managed Health Care (DMHC) and CA Department of Health Care Services (DHCS) **Essential Job Duties** - Facilitates comprehensive research and resolution of appeals, disputes, grievances, and/or complaints from Molina members, providers, and related outside agencies to ensure that internal and/or regulatory timelines are met. - Researches claims appeals and grievances using support systems to determine appropriate appeals and grievance outcomes. - Requests and reviews medical records, notes, and/or detailed bills as appropriate; formulates conclusions per protocol and other business partners to determine response; assures timeliness and appropriateness of responses per state, federal and Molina guidelines. - Meets claims production standards set by the department. - Applies contract language, benefits and review of covered services to claims review process. - Contacts members/providers as needed via written and verbal communications. - Prepares appeal summaries and correspondence, and documents findings accordingly (includes information on trends as requested). - Composes all correspondence, appeals/disputes and/or grievances information concisely, accurately and in accordance with regulatory requirements. - Researches claims processing guidelines, provider contracts, fee schedules and systems configurations, to determine root causes of payment errors. - Resolves and prepares written response to incoming provider reconsideration requests related to claims payment, requests for claim adjustments, and/or requests from outside agencies. **Required Qualifications** - At least 2 years of managed care experience in a call center, appeals, and/or claims environment, or equivalent combination of relevant education and experience. - Health claims processing experience, including coordination of benefits (COB), subrogation and eligibility criteria. - Experience with Medicaid and Medicare claims denials and appeals processing, and knowledge of regulatory guidelines for appeals and denials. - Customer service experience. - Strong organizational and time management skills; ability to manage simultaneous projects and tasks to meet internal deadlines. - Effective verbal and written communication skills. - Microsoft Office suite/applicable software program(s) proficiency. **Preferred Qualifications** - Customer/provider experience in a managed care organization (Medicaid, Medicare, Marketplace and/or other government-sponsored program), or medical office/hospital setting. - Completion of a health care related vocational program in health care (i.e., certified coder, billing, or medical assistant). To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V. Pay Range: $21.16 - $38.37 / HOURLY *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

Provides support for claims activities including reviewing and resolving member and provider complaints, and communicating resolution to members or authorized representatives in accordance with the standards and requirements established by the Centers for Medicare and Medicaid Services (CMS). **Essential Job Duties** - Facilitates comprehensive research and resolution of appeals, disputes, grievances, and/or complaints from Molina members, providers, and related outside agencies to ensure that internal and/or regulatory timelines are met. - Researches claims appeals and grievances using support systems to determine appropriate appeals and grievance outcomes. - Requests and reviews medical records, notes, and/or detailed bills as appropriate; formulates conclusions per protocol and other business partners to determine response; assures timeliness and appropriateness of responses per state, federal and Molina guidelines. - Meets claims production standards set by the department. - Applies contract language, benefits and review of covered services to claims review process. - Contacts members/providers as needed via written and verbal communications. - Prepares appeal summaries and correspondence, and documents findings accordingly (includes information on trends as requested). - Composes all correspondence, appeals/disputes and/or grievances information concisely, accurately and in accordance with regulatory requirements. - Researches claims processing guidelines, provider contracts, fee schedules and systems configurations, to determine root causes of payment errors. - Resolves and prepares written response to incoming provider reconsideration requests related to claims payment, requests for claim adjustments, and/or requests from outside agencies. **Required Qualifications** - At least 2 years of managed care experience in a call center, appeals, and/or claims environment, or equivalent combination of relevant education and experience. - Health claims processing experience, including coordination of benefits (COB), subrogation and eligibility criteria. - Experience with Medicaid and Medicare claims denials and appeals processing, and knowledge of regulatory guidelines for appeals and denials. - Customer service experience. - Strong organizational and time management skills; ability to manage simultaneous projects and tasks to meet internal deadlines. - Effective verbal and written communication skills. - Microsoft Office suite/applicable software program(s) proficiency. **Preferred Qualifications** - Customer/provider experience in a managed care organization (Medicaid, Medicare, Marketplace and/or other government-sponsored program), or medical office/hospital setting. - Completion of a health care related vocational program in health care (i.e., certified coder, billing, or medical assistant). To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V. Pay Range: $21.16 - $38.37 / HOURLY *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

Provides support for CA Medi-Cal and Marketplace benefits and services including reviewing and resolving member appeals and complaints, then communicating resolution to members or authorized representatives in accordance with the standards and requirements established by the CA Department of Managed Health Care (DMHC) and CA Department of Health Care Services (DHCS) **Essential Job Duties** - Facilitates comprehensive research and resolution of appeals, disputes, grievances, and/or complaints from Molina members, providers, and related outside agencies to ensure that internal and/or regulatory timelines are met. - Researches claims appeals and grievances using support systems to determine appropriate appeals and grievance outcomes. - Requests and reviews medical records, notes, and/or detailed bills as appropriate; formulates conclusions per protocol and other business partners to determine response; assures timeliness and appropriateness of responses per state, federal and Molina guidelines. - Meets claims production standards set by the department. - Applies contract language, benefits and review of covered services to claims review process. - Contacts members/providers as needed via written and verbal communications. - Prepares appeal summaries and correspondence, and documents findings accordingly (includes information on trends as requested). - Composes all correspondence, appeals/disputes and/or grievances information concisely, accurately and in accordance with regulatory requirements. - Researches claims processing guidelines, provider contracts, fee schedules and systems configurations, to determine root causes of payment errors. - Resolves and prepares written response to incoming provider reconsideration requests related to claims payment, requests for claim adjustments, and/or requests from outside agencies. **Required Qualifications** - At least 2 years of managed care experience in a call center, appeals, and/or claims environment, or equivalent combination of relevant education and experience. - Health claims processing experience, including coordination of benefits (COB), subrogation and eligibility criteria. - Experience with Medicaid and Medicare claims denials and appeals processing, and knowledge of regulatory guidelines for appeals and denials. - Customer service experience. - Strong organizational and time management skills; ability to manage simultaneous projects and tasks to meet internal deadlines. - Effective verbal and written communication skills. - Microsoft Office suite/applicable software program(s) proficiency. **Preferred Qualifications** - Customer/provider experience in a managed care organization (Medicaid, Medicare, Marketplace and/or other government-sponsored program), or medical office/hospital setting. - Completion of a health care related vocational program in health care (i.e., certified coder, billing, or medical assistant). To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V. Pay Range: $21.16 - $38.37 / HOURLY *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

Provides support for claims activities including reviewing and resolving member and provider complaints, and communicating resolution to members or authorized representatives in accordance with the standards and requirements established by the Centers for Medicare and Medicaid Services (CMS). **Essential Job Duties** - Facilitates comprehensive research and resolution of appeals, disputes, grievances, and/or complaints from Molina members, providers, and related outside agencies to ensure that internal and/or regulatory timelines are met. - Researches claims appeals and grievances using support systems to determine appropriate appeals and grievance outcomes. - Requests and reviews medical records, notes, and/or detailed bills as appropriate; formulates conclusions per protocol and other business partners to determine response; assures timeliness and appropriateness of responses per state, federal and Molina guidelines. - Meets claims production standards set by the department. - Applies contract language, benefits and review of covered services to claims review process. - Contacts members/providers as needed via written and verbal communications. - Prepares appeal summaries and correspondence, and documents findings accordingly (includes information on trends as requested). - Composes all correspondence, appeals/disputes and/or grievances information concisely, accurately and in accordance with regulatory requirements. - Researches claims processing guidelines, provider contracts, fee schedules and systems configurations, to determine root causes of payment errors. - Resolves and prepares written response to incoming provider reconsideration requests related to claims payment, requests for claim adjustments, and/or requests from outside agencies. **Required Qualifications** - At least 2 years of managed care experience in a call center, appeals, and/or claims environment, or equivalent combination of relevant education and experience. - Health claims processing experience, including coordination of benefits (COB), subrogation and eligibility criteria. - Experience with Medicaid and Medicare claims denials and appeals processing, and knowledge of regulatory guidelines for appeals and denials. - Customer service experience. - Strong organizational and time management skills; ability to manage simultaneous projects and tasks to meet internal deadlines. - Effective verbal and written communication skills. - Microsoft Office suite/applicable software program(s) proficiency. **Preferred Qualifications** - Customer/provider experience in a managed care organization (Medicaid, Medicare, Marketplace and/or other government-sponsored program), or medical office/hospital setting. - Completion of a health care related vocational program in health care (i.e., certified coder, billing, or medical assistant). To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V. Pay Range: $21.16 - $38.37 / HOURLY *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

Responsible for reviewing and resolving member and provider complaints and communicating resolution to members and provider (or authorized representatives) in accordance with the standards and requirements established by the Centers for Medicare and Medicaid **KNOWLEDGE/SKILLS/ABILITIES** + Responsible for the comprehensive research and resolution of the appeals, dispute, grievances, and/or complaints from Molina members, providers and related outside agencies to ensure that internal and/or regulatory timelines are met. + Research claims appeals and grievances using support systems to determine appeal and grievance outcomes. + Requests and reviews medical records, notes, and/or detailed bills as appropriate; formulates conclusions per protocol and other business partners to determine response; assures timeliness and appropriateness of responses per state, federal and Molina Healthcare guidelines. + Responsible for meeting production standards set by the department. + Apply contract language, benefits, and review of covered services + Responsible for contacting the member/provider through written and verbal communication. + Prepares appeal summaries, correspondence, and document findings. Include information on trends if requested. + Composes all correspondence and appeal/dispute and or grievances information concisely and accurately, in accordance with regulatory requirements. + Research claims processing guidelines, provider contracts, fee schedules and system configurations to determine root cause of payment error. + Resolves and prepares written response to incoming provider reconsideration request is relating to claims payment and requests for claim adjustments or to requests from outside agencies **JOB QUALIFICATIONS** **REQU** **I** **RED ED** **U** **C** **A** **TI** **O** **N** **:** High School Diploma or equivalency **REQU** **I** **RED E** **X** **PE** **R** **I** **E** **N** **C** **E:** + Min. 2 years operational managed care experience (call center, appeals or claims environment). + Health claims processing background, including coordination of benefits, subrogation, and eligibility criteria. + Familiarity with Medicaid and Medicare claims denials and appeals processing, and knowledge of regulatory guidelines for appeals and denials. + Strong verbal and written communication skills To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V. Pay Range: $21.16 - $38.37 / HOURLY *Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

PresNow is seeking a dedicated and compassionate Ultrasound Technologist to join our dynamic imaging team. This role is ideal for a candidate with experience as a general sonographer who is eager to expand their skillset into vascular imaging. We offer comprehensive training in vascular ultrasound to support your professional growth. Key Responsibilities: Perform high-quality general ultrasound exams, including but not limited to: Abdominal OB/Gyn Small parts Perform vascular ultrasound exams (training provided), including: Lower Extremity Venous (LEV) Lower Extremity Arterial (LEA) Upper Extremity Venous (UEV) Upper Extremity Arterial (UEA) Carotid studies Collaborate with physicians for accurate interpretation and treatment planning. Maintain patient comfort and safety throughout procedures. Participate in on-call rotation as needed. Type of Opportunity: Per Required Need FTE: 0.001000 Exempt: No Work Schedule: Varied Days and Hours How you belong matters here. At Presbyterian, it's not just what we do that matters. It's how we do it - and it starts with our incredible team. Our employees make a meaningful impact on the healthcare provided to our patients and members. Why Join Us Benefits: We offer a wide range of benefits including medical, wellness program, vision, dental, paid time off, retirement and more for FT employees. PRN/PT (working less than a .45 FTE) employee benefits available for this position such as medical, gym memberships and an employee wellness program. Responsibilities Successful transmission of images to PACS Schedules ultrasound cases to coordinate with other patient exams. Educates patient before scanning procedure explaining the procedure and answering patient questions. Prepares written documentation as required by the profession and ultrasound department policy such as blood pressures (pre and post exam) and post invasive procedure patient follow up. Maintains records of exam data and other pertinent information on patients. Uses Radiology Information System, hospital information systems as required. Assists physician in such procedures as needle biopsies, amniocentesis, renal biopsies, etc. Scans the patient mark the patient's body, determine the angle for puncture, and assist as necessary. Has knowledge of and maintains sterile technique. Maintains established hospital radiology and ultrasound policies, procedures, objectives, quality assurance, safety, environmental, and infection control standards. Selects proper technical factors on an individual patient basis. Positions and transfers patients comfortably. Assists in maintaining upkeep of department and equipment - including ordering and stocking supplies when necessary. Attends section staff meetings, pertinent in-services, workshops, and/or seminars for continuing education to enhance professional growth and development. Takes call for ultrasound procedures. Qualifications High School Diploma or GED Two years of ultrasound specific college coursework, associate degree or diploma in Diagnostic Medical Sonography. Trade or vocational school in vascular ultrasound may be considered with previous general ultrasound training. ARDMS eligible and must have two ARDMS registries within two years of hire. Must hold and maintain current New Mexico State Licensure (DMS-NM) under the New Mexico Medical Imaging and Radiation Therapy Program. Provisional or temp license may be considered. Current BLS required Education: Essential: High School Diploma or GED Credentials: Essential: NM Diagnositc Medical Sonography Reg Diagnostic Med Sonographer Current BLS is required. Benefits We're all about well-being, starting with yours. Presbyterian employees have access to a fun, engaging and unique wellness program, including free on-site and community-based gyms, nutrition coaching and classes, mindfulness and meditation resources, wellness challenges and more. Learn more about our employee benefits. About Presbyterian Healthcare Services Presbyterian exists to improve the health of patients, members and the communities we serve. We are a locally owned, not-for-profit healthcare system comprised of nine hospitals, a statewide health plan and a growing multi-specialty medical group. Founded in New Mexico in 1908, we are the state's largest private employer with nearly 13,000 employees - including more than 1,200 providers and nearly 3,500 nurses. Our health plan serves more than 640,000 members statewide and offers Medicare Advantage, Medicaid (Centennial Care) and Commercial health plans. AA/EOE/VET/DISABLED. PHS is a drug-free and tobacco-free employer with smoke free campuses. Maximum Offer for this position is up to USD $47.83/Hr. Compensation Disclaimer The compensation range for this role takes into account a wide range of factors, including but not limited to experience and training, internal equity, and other business and organizational needs. We can recommend jobs specifically for you! Click here to get started.