Author Archives: VWAH

Some responsibilities include:

Review medical record information to identify all appropriate coding based on CMS HCC categories.
Complete appropriate paperwork/documentation/system entry regarding claim/encounter information.
Provide support, education and training related to, quality of documentation, level of service and diagnosis coding consistent with established coding guidelines and standards.
Provide real time support and coordination with Primary Care Providers and Care Coordinators for MRA coding, HEDIS and STARS.
Coordinate with clinical leadership in the development of provider training plans and for active support in the training process.
Organize and schedule periodic training as indicated from chart review results, and/or as requested by medical leadership or CBO management.
Monitor Coding changes to ensure that most current information is available.
Provides coding support to CBO as requested.
Other duties as may be assigned.

Key Competencies:

Builds Trust: Consistently models and inspires high levels of integrity, lives up to commitments, and takes responsibility for the impact of one’s actions.
Pursues Excellence: Seeks out learning, strives to develop and expand personally, and continuously helps others upgrade their capability to contribute to Humana.
Executes for Results: Effectively leverages resources to create exceptional outcomes, embraces change, and constructively resolves barriers and constraints.
Collaborates: Engages others by gathering multiple views and being open to diverse perspectives, focusing on a shared purpose that puts Humana’s overall success first

Qualifications

Role Essentials

CPC, CRC.CCS-P Coding Certification
CPC-A with coding experience
18+ months of prior medical coding experience
Strong organization and process management skills
Strong collaboration and relationship building skills
Training and presentation experience
Excellent written verbal and written communication skills
Proficient with Microsoft Word, PowerPoint and Excel
Ability to drive to provider offices and be in the field approximately 75%

Role Desirables

HCC coding experience
Meidcare knowledge
Prior experience in a fast paced insurance or health care setting
Associate or Bachelor’s degree

Some responsibilities include:

Description

Support the HS Net Ops Sr. Analyst role. Below are specific tasks they perform on an ongoing basis:

– Process all new incoming applications & contracts from all locations of market

– Process ACD (Add, Change, Delete) notifications for the large delegated groups that have been assigned on a monthly basis

– Maintain provider contract files (permanent files) and system information on an ongoing basis

– Prepare &/or copy meeting packets, HEDIS/STAR packets, orientation packets, and provider educational memos as needed

– Assist with provider calls for claims questions, enrollment questions, referral questions, etc as needed for the North East Texas market

– Research and resolve provider issues for claims for the market as needed

– Manage the HS Connect email requests, daily

– Update Directory Addendums for all H plans (preferred health plans) on a monthly basis, or as needed

– Assist with any fax notifications for Admits, ER visits, or any other Health Services educational documentation throughout the year.

– Work with HS Net Ops Sr. Analysts team as needed to focus on daily ADK (Admits per Thousand), monthly top 1% membership report, and monthly catastrophic report (all year)

– Assist in the development and mailing of any termination letters for provider network

– Manage the Network Interest Process & participate in QIC (quality improvement committee) meeting monthly

– Review the Credentialing Internal SharePoint site page every week for any newly credentialed provider. Once identified, print out profile and give to appropriate Net Ops Rep for processing

Qualifications

US Candidates Only: Qualified applicants will be considered for employment without regard to race, color, religion, national origin, sex, sexual orientation, gender identity, disability, veteran status. If you require a special accommodation, please visit our Careers website or contact us at SeeYourself@cigna.com.

Qualifications

High School Diploma or equivalent

Bachelor’s Degree preferred

Proficient at Microsoft Office products and learning reporting applications

Excellent communication, verbal and written skills

25% local Travel within East Texas/Lufkin service area

Some responsibilities include:

JOB SUMMARY

An Account Executive (AE) establishes, nurtures, and retains business relationships with mortgage brokers and correspondents to facilitate the acquisition of a wide variety of residential mortgage loan products and services through the Company’s extensive business-to-business network of correspondents and brokers. The incumbent is responsible for managing all assigned Client accounts to include educating the clients in every aspect of the business relationship. An AE is typically assigned to a specific geographic area.

ESSENTIAL FUNCTIONS

Identifies and aggressively pursues prospective clients within the assigned geographic territory. Regularly secures new Client relationships, and successfully guides new Clients though the Client approval process. Actively promotes the various features and benefits of establishing/maintaining a business relationship with the Company. Learns, understands, and analyzes the Client’s business model and offers consultation as to what products and services may best meet the client’s business needs. Learns and analyzes assigned Clients’ business model and scorecard rating, focusing on eSign execution, rate lock pull-through performance, deficiency ratios, and other applicable quality or sales performance metrics.

EDUCATION AND EXPERIENCE

Bachelor’s degree in related field or equivalent lending experience in a financial institution. Minimum two years direct sales experience in a mortgage banking environment, preferably in a residential wholesale lending capacity.

KNOWLEDGE, SKILLS AND ABILITIES

Thorough knowledge of and the ability to apply concepts to all aspects of residential mortgage lending, origination’s, operations and delivery. Possesses refined marketing skills that can be applied to the wholesale lending environment. PC literacy; proficiency with Microsoft Office products.

Some responsibilities include:

The GDR Group, a stable, dynamic and innovative IT Solutions Provider based in Irvine, CA servicing regionally and nationally – based clients. We provide managed services and business-to-business solutions for today’s technologically dependent businesses.

We are currently seeking …
A Desktop Support Services L2 Technician that possesses a strong customer service orientation, sound technical skills, integrity and a passion for excellence. The right candidate will be extremely detail oriented, able to multi-task in a demanding environment, and possesses exceptional communication and organizational skills. The right candidate will have a “do whatever it takes” attitude and possess great pride in their work.

Essential Functions:

Analyze and resolve moderately complex information system issues for clients. Issues will be related to the desktop computing environment, network applications, production applications, and hardware.
Respond to and resolve client issues concerning systems operation within established Service Level Agreements (SLA).
Closely monitor ticket queue to provide quality assurance of tickets in progress.
Document all end-user requests and interactions in ticketing system.
Resolve, route or escalate service requests to functional teams as necessary.

Qualifications

Minimum 2+ years’ experience in a corporate Helpdesk and/or desktop support environment.
Thorough understanding of Windows 7 and Mac Operating Systems.
Strong Hardware and software troubleshooting skills is a must.
Excellent customer service skills to work effectively with clients
Possess excellent organizational skills
Ability to work well with other people in a team oriented environment.
Must be professional, self-motivated, resourceful, flexible and work with minimal supervision
Must be able to set priorities and be flexible in a fast paced environment.
Understanding and experience with the following Coloration Services – Google Enterprise Apps, BOX, Video, WebEx & Audio Conference
Understanding and experience with Standard Office software & applications (ex: MS Office, Cisco Jabber client & Browsers – Chrome etc)
Must understand and communicate difficult concepts and provide instructions in a clear and straightforward manner.
Ability to troubleshoot client-side MS Exchange problems.
Ability to troubleshoot network port / wireless connectivity issues.
Ability to follow through and document issues and resolutions
Must be able to follow procedures and protocols as outlined by Senior Management.