Neighborhood Health Plan Jobs in Arlington

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

Jobs 1 to 20 of 20
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: 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: Support the managed care transaction system configuration changes and new configuration requirements including configuration analysis, design, build and test. Configuration support to include, but not limited to, provider data management, provider contracts, benefit plans and employer groups Implement and improve operational efficiencies. Maximize QNXT capabilities Ana...
Primary Responsibilities: Collaborate with key business partners such as: Finance Operations, 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, ...
Primary Responsibilities: The Care Manager will assess, plan, implement, and evaluate care plans for NHP members. He/she will collaborate with social care managers, as well as behavioral health care managers, to develop a comprehensive approach to care coordination: Use of evaluative and outcomes data to improve ongoing care management services Promotion of health care outcomes in concert with ...
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: Responsibilities include conducting standardized assessments on all high-risk members including those identified through the Health Needs Assessment (HNA) process, enrollment and trigger reports, and other case identification sources, and establishing and implementing culturally competent care management plans to meet the needs of members. The CM will participate in qua...
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: 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: 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: 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: Provide administrative support to care managers, and assist with outreach to health centers regarding clinical questions and program support by maintaining frequent consistent contact with the health center and its staff Respond in a timely and accurate manner to internal and external customer inquiries regarding NHP and Clinical administrative policies and procedures ...
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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