Job Description. Job Description. Role Summary. The Credentialing and Network Coordinator will be responsible for ensuring the data integrity for our contracted providers and facilities. This includes conducting ongoing auditing of the departments’ database, monitoring regulatory agencies requirements, participation status with payer programs, and other demographic, credentialing, and contractual requirements. The Credentialing and Network Coordi...
Description. Position Summary. . Responsible for contracting and operational oversight functions for vendors in connection with each business unit owner to avoid risk, reduce spend, improve efficiency, and enhance the quality of vendor relationships and their respective products and/or services. Oversees the overall delivery of multiple and/or complex projects. Defines priority through administrative ownership of the Project Governance Board and ...
Job Description. Job Description. Job Title: Coordinator, Utilization Management. Department: Medical Management. Supervisor: UM. Supervisor/Manager. Medical Management. The Utilization Management Coordinator represents the company by serving as the frontline point of contact to providers and members for the utilization review (UR) of healthcare services. The UM Specialist works within prescribed guidelines and procedures. uses independent judgme...
Summary The Commercial Health Plan Enrollment Specialist i s responsible for maintenance of eligibility data, resolving all issues or requests regarding eligibility, facilitating enrollment of potential members, and rendering any needed system updates. Will collaborate in analyzing issues that impact and affect the Eligibility Departments processes and procedures and provide feedback and recommendations. Essential Functions include the following....
Summary. The Apex customer service team is responsible for addressing all forms of member and provider inquiries (phone, email, internet and/or written correspondence) in a clear, consistent, professional and caring manner. The incumbent must be able to demonstrate the knowledge needed to perform all job-related skills and accountabilities as outlined below. Essential Duties and Responsibilities. include the following. Other duties may be assigne...
Job Description. Job Description. Job Title. Member Concierge Representative. Department. Customer Service. Reports To. Supervisor, Customer Service. Position Summary. Apex Health Solutions is expanding our services by building a member concierge. team to assist our client’s health plan members with onboarding processes and questions. This. position will be one of the initial points of contact with our client organization membership and. shall pr...
Summary. Apex Health Solutions is leading a healthcare transformation through our partnerships with physicians and healthcare insurers. Through our unique models, Apex empowers physicians to truly manage a patient’s health, delivering high quality, affordable care in a modern, patient focused approach. The EDI Business Analyst is responsible for ensuring EDI transmissions meet platform specifications in terms of business requirements, application...
SUMMARY: The Practice Transformation Specialist (PTS) is responsible for all value-based care initiatives, interventions to support the implementation and transition to Value Based Healthcare processes. The PTS reports to the Manager, Practice Transformation. The PTS is responsible for providing on-site and remote assistance and /or education to clinicians, care teams and their associated practices to drive improvement in clinical quality, risk a...
SUMMARY: Risk Adjustment Coder is responsible for reviewing, abstracting, and coding inpatient and/or outpatient medical records to ensure proper ICD-10 coding and compliance with risk adjustment requirements. Reports to: AVP, STARs & Risk Adjustment Location: Houston, TX EDUCATION: High School Diploma or GED Required LICENSES/CERTIFICATIONS: A certification in one of the following is required: Certified Risk Adjustment Coder (CRC) Certified Prof...
Job Title: Analyst, Utilization Management. Department: Medical Management. Supervisor: UM Manager. Summary. Utilization Management (UM) Analyst represents the company by assisting leadership in ensuring regulatory compliance of UM processes. The Utilization Management Analyst will maintain standard compliance and performance related utilization management data. Working within prescribed guidelines and procedures, uses independent judgment requir...
Summary. Apex Health Solutions is leading a healthcare transformation through our partnerships with physicians and healthcare insurers. Through our unique models, Apex empower physicians and risk-bearing organizations to truly manage a patient’s health, delivering high quality, affordable care in a modern, patient focused approach. The Healthcare Data Analyst is responsible for the synthesis and presentation of insights using Apex BI solutions, a...
Position Summary. . Assist supervisors in managing the call center, respond to emails and questions, maintain processes, and resolve complaints or disputes while ensuring high-quality service standards. This position will also assist with escalated inquiries and provide excellent customer service. Essential Duties and Responsibilities. . To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. Ot...
