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BlueCross BlueShield of South Carolina
- Charleston, SC / Atlanta, GA / Burlington, VT / 33 more...
As member of the senior management team, provides administrative oversight to the medical staff, analyzes medical review utilization data, researches new medical procedures or technology, and acts as a resource to providers and internal staff on issues concerning medical policies. May also write and revise medical policies. Description Supports operations in the form of c
Posted 3 days ago
BlueCross BlueShield of South Carolina
- Washington, DC / Wilmington, DE / Blue Bell, PA / 8 more...
Companion Data Services (CDS) is a part of the Celerian Group, a consortium of companies which act as subsidiaries to BlueCross BlueShield of South Carolina. CDS provides leading IT solutions and managed services. We operate multiple geographically disperse data centers, including two of the nation's largest healthcare data centers both rated among the top five percent of
Posted 3 days ago
BlueCross BlueShield of South Carolina
- Birmingham, AL / Atlanta, GA / Burlington, VT / 46 more...
Responsible for completing cost report reopenings within established timeframes and ensuring that the quality of our work meets CMS expectations. Reopenings include review of various provider types and issues related to the Medicare cost report. Description Conducts internal and external timely operational, compliance, and financial audits of divisions, departments, provi
Posted 5 days ago
BlueCross BlueShield of South Carolina
- Charleston, SC / Atlanta, GA / Burlington, VT / 45 more...
Provides key financial reports/analysis to support senior management in planning/evaluation requirements/meeting financial objectives related to strategic Pharmacy Benefit Management (PBM) services. Performs analysis, validation and oversight of Corporate PBM Agreement and self funded employer PBM Addenda. Conducts complex market research/competitive analysis/valuation/fi
Posted 5 days ago
Responsible in the provider enrollment process to review, research, analyze, and process provider enrollment applications. Ensures provider file integrity and that suppliers are in compliance with established standards and guidelines. Description May perform any or all of the following in the enrollment of providers determines the acceptability of provider enrollment appl
Posted 5 days ago
BlueCross BlueShield of South Carolina
- Birmingham, AL / Atlanta, GA / Burlington, VT / 48 more...
Responsible for providing a full range of financial, compliance, and operational audits, business advisory and consultation services, investigations, internal controls, accountability, and use of resources. Description Conducts internal and external timely operational, compliance, and financial audits of divisions, departments, providers, and activities of the corporation
Posted 6 days ago
BlueCross BlueShield of South Carolina
- Charleston, SC / Atlanta, GA / Burlington, VT / 47 more...
Involved in all aspects of the Molecular Diagnostic Program (MoIDX) laboratory operations and serves as an internal subject matter expert, applying medical knowledge to advise decisionmakers in support of MoIDX's mission. Responsible for review and approval of documentation and reports, supporting clinical testing strategies, as well as new assay development and validatio
Posted 6 days ago
BlueCross BlueShield of South Carolina
- Charleston, SC / Blue Bell, PA / Wilmington, DE / 23 more...
Negotiates Pharmacy Benefit Management (PBM) contract terms with Commercial Business self funded groups for retail/mail order/specialty pharmacy service and specialty drug medical management rebate sharing services. Monitors contract performance including performance guarantees, financial guarantees, and compliance with state and federal regulatory requirements specific t
Posted 10 days ago
As member of the senior management team, provides administrative oversight to the medical staff, analyzes medical review utilization data, researches new medical procedures or technology, and acts as a resource to providers and internal staff on issues concerning medical policies. May also write and revise medical policies. Description This position can be worked remotely
Posted 10 days ago
BlueCross BlueShield of South Carolina
- Charleston, SC / Atlanta, GA / Burlington, VT / 46 more...
Provide molecular diagnostic expertise to suggest improvements on the standardization of processes for provider coverage determinations. Focus is reviewing molecular, genetic, and esoteric tests for unique characteristics. Provide guidance on updates and improvements to identifiers and development of processes. Description Reviewing/assigning/maintaining unique identifier
Posted 11 days ago
BlueCross BlueShield of South Carolina
- Columbia, SC / Atlanta, GA / Burlington, VT / 48 more...
Responsible for providing a full range of financial, compliance, and operational audits, business advisory and consultation services, investigations, internal controls, accountability, and use of resources. Description Position Purpose In this role, you will be responsible for assisting with and administering underwriting audits for internal and external partners' non maj
Posted 13 days ago
BlueCross BlueShield of South Carolina
- Columbia, SC / Atlanta, GA / Burlington, VT / 48 more...
Responsible for providing a full range of financial, compliance, and operational audits, business advisory, and consultation services, investigations, internal controls, accountability, and use of resources. Description Conducts internal and/or external timely operational, financial, and/or compliance audits of divisions, departments, providers, and activities of the corp
Posted 13 days ago
BlueCross BlueShield of South Carolina
- Columbia, SC / Atlanta, GA / Burlington, VT / 48 more...
Responsible for providing a full range of financial, compliance, and operational audits, business advisory, and consultation services, investigations, internal controls, accountability, and use of resources. Description Conducts internal and/or external timely operational, financial, and/or compliance audits of divisions, departments, providers, and activities of the corp
Posted 13 days ago
BlueCross BlueShield of South Carolina
- Springfield, IL / Atlanta, GA / Burlington, VT / 47 more...
Responsible for providing a full range of financial, compliance, and operational audits, business advisory, and consultation services, investigations, internal controls, accountability, and use of resources. Description This position is remote. 50% Conducts internal and/or external timely operational, financial, and/or compliance audits of divisions, departments, provider
Posted 13 days ago
BlueCross BlueShield of South Carolina
- Springfield, IL / Atlanta, GA / Burlington, VT / 49 more...
Responsible for providing a full range of financial, compliance, and operational audits, business advisory and consultation services, investigations, internal controls, accountability, and use of resources. Description This position is remote. 40% Conducts internal and external timely operational, compliance, and financial audits of divisions, departments, providers, and
Posted 27 days ago
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