PRINCIPAL RESPONSIBILITIES. . Under general supervision of the Manager, Networks and Contacting, the Contract Specialist coordinates the day-to-day work processes associated with the contracting process. This includes developing, maintaining and executing contracts (new and revised) as well as changes to DOFRs (Divisions of Financial Responsibilities) affiliated with delegated groups. This position also manages the receipt and development of Let...
PRINCIPAL RESPONSIBILITIES. Member Services Representatives (MSR) are the first point of contact for our members’ primary contact with the Alliance for both routine and complex member issues with the goal of delivering excellent customer service to our customers. The position is responsible for answering a high volume of inbound and outbound calls in a timely manner. Respond to all communications coming into Member Services in the form of email,...
PRINCIPAL RESPONSIBILITIES. . Under general supervision of the Manager, Networks and Contacting, the Contract Specialist coordinates the day-to-day work processes associated with the contracting process. This includes developing, maintaining and executing contracts (new and revised) as well as changes to DOFRs (Divisions of Financial Responsibilities) affiliated with delegated groups. This position also manages the receipt and development of Let...
PRINCIPAL RESPONSIBILITIES. . The Senior Project Manager, under the direction of the Sr Manager, Project Management Office (PMO). . is responsible for providing management and support for project development and implementation throughout Alameda Alliance’s project portfolio. These projects may have business and/or technical components of healthcare operations including claims, membership, utilization and disease management, provider services, fin...
PRINCIPAL RESPONSIBILITIES. . Under the supervision of the Senior Manager, Financial Planning and Analysis (FP&A) - Healthcare, the Lead Financial Analyst, Healthcare Finance. is responsible to support the Finance Department in the areas of special projects, financial analysis and reporting as well as review work completed by other analysts. The position requires a high-level of understanding of medical financial data and health plan operations, ...
PRINCIPAL RESPONSIBILITIES. . Under the general direction of the Supervisor, Health Plan Audits,this position is responsible for supporting the Alameda Alliance for Health’s (AAH) Compliance Program, with an emphasis on external/delegate auditing activities. Principal responsibilities include. Lead and/or coordinate external audits of AAH delegated entities to ensure compliance with regulatory and contractual requirements and controls.Recommend o...
PRINCIPAL RESPONSIBILITIES. . Under administrative supervision, this position performs mailroom, department assistance and hospitality coordination and functions as needed including department/company support with well-defined assignments that require minimal instructions and supervision. Additional functions also include good communication and customer service, problem-solving, spreadsheets, and full support for the Alliance and Facilities. Abil...
PRINCIPAL RESPONSIBILITIES. . Under general direction from the Director, Claims, the Senior Manager, Claims Operations Support is responsible for the management and oversight of the Claims Operations Support function which includes, but is not limited to, research and resolution of claim payment issues, auditing, refund processing and claims system analysis/testing activities. the Provider Dispute Resolution (PDR) function. and the Other Health C...
PRINCIPAL RESPONSIBILITIES. . Under the direct supervision of the Claims Processing Supervisor and the general direction of the Manager, Claims Production, this position is responsible for the accurate review, entry and processing of all claims received for payment by AAH. . Principal responsibilities include. . . Research claims for completion and appropriateness. . Review and handle rejected claims as necessary. . Evaluate HealthSuite error scr...
P. RINCIPAL. RESPONSIBILITIES. Member Services Representatives (MSR) are the first point of contact for our members’ primary contact with the Alliance for both routine and complex member issues with the goal of delivering excellent customer service to our customers. The position is responsible for answering a high volume of inbound and outbound calls in a timely manner. Respond to all communications coming into Member Services in the form of ema...
PRINCIPAL RESPONSIBILITIES. Member Services Representatives (MSR) are the first point of contact for our members’ primary contact with the Alliance for both routine and complex member issues with the goal of delivering excellent customer service to our customers. The position is responsible for answering a high volume of inbound and outbound calls in a timely manner. Respond to all communications coming into Member Services in the form of email, ...
PRINCIPAL RESPONSIBILITIES. Under the general supervision of the Manager, Claims Operation Support, the principal responsibilities of the Claims Specialist include. Audit Activities. Audit a designated percentage of all daily processing production for assigned staff members (including errors from claims pricing, adjudication, adjustments, member bill issues, and mail). Conduct periodic focused claims audits to determine if the correct adjudicatio...
