Managed Healthcare Specialist

Direct Placement - 29964 $55,000 - $75,000 per Year Location: West Des Moines, Iowa Industry: Healthcare

Are you looking for a chance to use your interpersonal skills in a growing, rapidly evolving environment? Our West Des Moines client is looking for a Managed Healthcare Specialist on a direct hire basis. Qualified applicants will have at least 2 years of managed healthcare and provider reimbursement experience, and ideal candidates will also have health information management experience. If you are looking for an opportunity to build a team, processes and a culture within this new department and have the correct related experience, apply today!

Responsibilities:

  • Lead health plan provider orientation and educate providers on an ongoing basis
  • Educate providers regarding policies and procedures related to referrals, claims, credentialing, or electronic health information
  • Investigate, document and resolve provider matters to improve provider partnership
  • Perform detailed Health Benefits Ratio and HEDIS analyses, and create reports for provider
  • Review provider performance for quality
  • Create and communicate documents and improvement metrics
  • Act as a liaison between the providers and health plans to ensure a coordinated effort in improving financial and quality performance
  • Conduct site visits as required
  • Work on special projects, reports and change requests

Requirements:

  • Bachelor’s degree in related field or equivalent experience
  • 2+ years of combined managed healthcare and provider reimbursement experience
  • Advanced knowledge of Microsoft Excel
  • Clinical or health information management (HIM) experience preferred
  • Claims processing and/or managed care experience preferred
  • Ability to travel up to 25%

Hours: 8:00AM-5:00PM Monday-Friday

Interested and qualified candidates can contact Lauren Sommers at (515) 225-7000 or email her at resumes@thepalmergroup.com.

How to Apply
Apply Online

–Or–
Palmer Group Contact:

Lauren Sommers - Resumes
resumes@thepalmergroup.com