Neighborhood Health Plan Jobs in Arlington

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16 Neighborhood Health Plan jobs in Arlington, Massachusetts found on Monster.

Jobs 1 to 16 of 16
Primary Responsibilities: Responsible for managing day to day enrollment activities including overseeing EDI files, processing rejected transactions, paper enrollments and enrollments received via the NHP Online Enrollment website. Responsible for overseeing EDI files, working fall outs, and processing monthly reconciliations with accounts, member enrollment letters, and managing paper applicati...
Primary Responsibilities: Preparation of various regulatory filings to the Division of Insurance, MassHealth and the Health Connector Responsible for all journal entries and transactions for assigned accounts Responsible for monthly account reconciliations for assigned accounts including resolution of variances Assist in the review of monthly financial statements Assist in the preparation of ...
Primary Responsibilities: Evaluates, negotiates and recommends necessary changes to existing ancillary provider contracts to ensure that targeted provider performance and financial goals are met. This includes detailed and on-going analysis of a provider’s ability to meet quality, performance and financial objectives. Negotiates contracts with new providers under the direction of the Manager of ...
Primary Responsibilities: The successful candidate will have excellent staff management skills, written and verbal communication skills, as well as an understanding of utilization management and case management processes and clinical quality. Experience with Medicaid, project management, benefit & contract management, presentation development and compliance is preferred. A. Staff Management Eff...
Primary Responsibilities: Evaluate, negotiate and recommend necessary changes to existing contracts to ensure that targeted provider performance and financial goals are met. Plays a kery role, as part of the team, working on and supporting special risk programs such as the Share Savings program as well as other risk programs. Identify medical cost improvement opportunities, the development of c...
Primary Responsibilities: Test Execution Assuming a leadership role for all aspects of testing within a project Coordinating test execution, including tasks, timeline and resource management between all impacted areas; systems, business analysts, business partners, and vendor. Directing, managing, planning and executing the testing activities for all appropriate projects. Preparing activity a...
Primary Responsibilities: Programming, including writing T-SQL in SQL Server and SSIS packages, which support the Vendor Interfaces. Analyze business and system requirements, including impact analyses on existing systems, to develop systems specifications In partnership with the business units, design, prepare and execute unit test plans for application upgrades and enhancements. General data ...
Primary Responsibilities: Collaborate with key business partners such as: Claims Processing, Member Services, Member Enrollment, Clinical Operations, Provider Relations, Provider Audit, and Business Development Departments to support business operations and understand how current and future systems enhancements may improve business processes and productivity. Elicit, gather, create and document ...
Primary Responsibilities: Develop test plans, test and execute automation where appropriate; write test plans and scripts Review and interpret the ANSI HIPAA EDI Companion Guides and Implementation Guides Develop EDI test plans, test EDI transaction (X12) where appropriate; execute these test cases and review the results Lead testing team through the execution of the test cycle. Provide direc...
Primary Responsibilities: Participates in conducting readiness organizational self-assessments for NCQA accreditation by conducting chart reviews, reviewing documented procedures and providing guidance to relevant individuals. Assists in the preparation of the organization’s submission to NCQA by organizing, referencing and uploading supporting documents as required by the NCQA interactive surve...
Primary Responsibilities: Optimizes the process for gathering and analyzing information from multiple sources to provide routine and ad hoc reporting in support of Operations. Ensure the accurate delivery of daily, weekly, monthly, quarterly and yearly status reporting to Operations leadership and the Executive Committee. Identify and communicate trends in customer interactions with NHP. This i...
Primary Responsibilities: Essential Functions As part of the Contract Finance Team for Medical Economics, guides and oversees efforts to efficiently provide management information in support of Provider Risk-Sharing arrangements. In conjunction with IT, PNM, and Finance colleagues, designs and executes reporting for multiple alternative payments, provides information to facilitate the in-depth ...
Primary Responsibilities: Programming, including writing T-SQL in SQL Server and SSIS packages, which support the Vendor Interfaces. Analyze business and system requirements, including impact analyses on existing systems, to develop systems specifications In partnership with the business units, design, prepare and execute unit test plans for application upgrades and enhancements. General data ...
Primary Responsibilities: Responsible for the development and maintenance of pricing source libraries, files, and fee schedules on a regular basis, using Medicare, Medicaid, NDC, and other pricing sources. In conjunction with actively monitoring both local and national industry regulations relating to fee schedules and adopted payment methodologies. Create reports and present written recommendat...
Primary Responsibilities: Leadership, Development, & Operations Management Responsible for managing the day-to-day operations of the Provider Relations team. Coach and develop Provider Relations Managers/Coordinator to maximize their abilities, develop core-competencies, and ensure understanding of team mission and goals. Consistently embrace change, act as a forward thinker, and model a posit...
Primary Responsibilities: Staff Management Effectively deploy allocated resources Staff performance management Staff growth and development Internal and external communication on a team and individual basis Infrastructure Enhancement Participate in system enhancement planning & development Provide ongoing and actionable communication to internal departments (e.g., contracting, credentialin...

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