…by communicating medical information required by all external review entities, managed care contracts, insurers, fiscal intermediaries, state, and federal

…including community oncology groups, hospital/IDN systems, academic medical centers, managed care organizations, pharmacy benefit management companies, payer

…skills + Ability to work autonomously + Working knowledge of insurance coverage, managed care and community resources Knowledge, Skills and Abilities: + Ability

…in claims-based healthcare analytics with a payer, provider, clinical vendor, managed care , or related healthcare consulting entity- Required.** **Ability

…to clinical records and other agency standards. Ensure all credentialing paperwork for managed care and other reimbursement parties is maintained in compliance

…abreast of regulatory processes and payer systems such as Medicare, Medicaid, managed care , and private sources, as applicable. Demonstrate extensive advanced

…State agencies (eg, SDOH, SOMH, OASAS, OPWDD), community health, mental health, and managed care organizations around psychiatric and other health services at

…identify and expand relationship development. + Integrate consultant activities to maximize managed care and other contractual relationships. + Assist with the

…Spectrum has a seat at the table with healthcare systems, employers, insurers, managed care organizations, and policymakers. When it comes to making decisions

…insurance benefits, Medicaid and other government programs, financial assistance, hospital billing and/or managed care contracts is required. 4 + years of recent