13 associate director quality assurance jobs found

CareFirst BlueCross BlueShield Resp & Qualifications PURPOSE: The Appeals Specialist I is responsible for the initial analysis of appeals and/or grievance correspondence, and determination of next steps for Commercial and FEP lines of business. Responsible for collecting, organizing and tracking information to facilitate and expedite processing of appeals and/or grievances received from a variety of sources. We are looking for an experienced professional to work remotely from within the greater Baltimore metropolitan area. The incumbent will be expected to come into a CareFirst location periodically for meetings, training and/or other business-related activities. ESSENTIAL FUNCTIONS: Prioritize, research and analyze all pertinent information in preparation of an appeal and/or grievance request. Access the appropriate database to implement accurate and timely entry of appeal, grievance and/or reconsideration correspondence and updates the appropriate referral...

Transamerica Job Family Product Development / Implementation About Us At Transamerica, hard work, innovative thinking, and personal accountability are qualities we honor and reward. We understand the potential of leveraging the talents of a diverse workforce. We embrace an environment where employees enjoy a balance between their careers, families, communities, and personal interests. Ultimately, we appreciate the uniqueness of a company where talented professionals work collaboratively in a positive environment - one focused on helping people look forward and plan for the best life possible while providing tools and solutions that make it easier to get there. Who We Are We believe everyone deserves to live their best life. More than a century ago, we were among the first financial services companies in America to serve everyday people from all walks of life. Today, we're part of an international holding company, with millions of customers and...

CareFirst BlueCross BlueShield Resp & Qualifications PURPOSE: The Broker Relations Manager's primary responsibility is to bring the value of CareFirst to the marketplace by engaging and working with CareFirst's distribution channel (brokers). This role combines strategic leadership with hands-on management to ensure brokers receive timely, accurate, and comprehensive assistance. The ideal candidate will foster a customer-centric culture while driving operational excellence and team development. ESSENTIAL FUNCTIONS: Broker Relationship Management Serve as the primary escalation point for complex broker inquiries and issues, ensuring timely and satisfactory resolution. Build and maintain strong relationships with key broker partners, full service producers and consultants, understanding their needs and business objectives. Monitor broker satisfaction metrics and implement strategies to improve service delivery and partner experience. Collaborate with sales...

CareFirst BlueCross BlueShield Resp & Qualifications We are looking for an experienced professional in the greater Baltimore/Washington metropolitan area who is willing and able to work in a hybrid model. The incumbent will be expected to work a portion of their week from home and a portion of their week at a CareFirst location based on business needs and work activities/deliverables that week. PURPOSE: This role will lead, guide, strategize and manage negotiations for provider-specific institutional, ancillary, and professional contracts. Key responsibilities include negotiating contract terms in accordance with regulatory requirements, analyzing financial data to evaluate implications across various business lines, while ensuring compliance with company policies and procedures, and coordinating with the Payment Transformation team to transition fee-for-service arrangements to value-based care. This role will also oversee complex projects related to provider...

CareFirst BlueCross BlueShield Resp & Qualifications PURPOSE: The Specialist, Account Installation II is responsible for the installation of more complex assigned accounts into core platforms and complimentary systems, including, but not limited to: development of the account structure and billing set up to align with documented account requirements, coordination of structure revisions, researching and resolving setup and structure issues, database management, and management of related administrative documents. Provide new hire support through training and pre-auditing as well as cross-training existing associates. ESSENTIAL FUNCTIONS: Perform installation of more complex assigned accounts, including, but not limited to: development of the account structure and billing set up to align with documented account requirements, coordination of structure revisions, researching and resolving setup and structure issues, database management, and management of related...

Transamerica Job Family Actuarial About Us At Transamerica, hard work, innovative thinking, and personal accountability are qualities we honor and reward. We understand the potential of leveraging the talents of a diverse workforce. We embrace an environment where employees enjoy a balance between their careers, families, communities, and personal interests. Ultimately, we appreciate the uniqueness of a company where talented professionals work collaboratively in a positive environment - one focused on helping people look forward and plan for the best life possible while providing tools and solutions that make it easier to get there. Who We Are We believe everyone deserves to live their best life. More than a century ago, we were among the first financial services companies in America to serve everyday people from all walks of life. Today, we're part of an international holding company, with millions of customers and thousands of employees...

CareFirst BlueCross BlueShield Resp & Qualifications PURPOSE: The Risk Adjustment Coding Operations Supervisor supports the execution of the corporate coding strategy across Medicare Advantage, Medicaid, and ACA markets. This role ensures operational compliance by supervising day-to-day activities, monitoring performance metrics, and facilitating cross-functional internal and external collaboration to drive cost-effective coding operations. This role is also responsible for overseeing regulatory compliance through interrater reliability monitoring and surveillance of high-risk conditions from the accurate collection, submission, and validation of risk adjustment data. Ensuring compliance with regulatory standards that ensure accurate and complete performance under various risk adjustment programs. ESSENTIAL FUNCTIONS: Supervise day-to-day activities and operational processes of the coding operations team - including HCC coding, auditing and data submission to CMS...

CareFirst BlueCross BlueShield Resp & Qualifications (Live in CareFirst service area) PURPOSE: This role will lead, guide, strategize and manage negotiations for provider-specific institutional, ancillary, and professional contracts. Key responsibilities include negotiating contract terms in accordance with regulatory requirements, analyzing financial data to evaluate implications across various business lines, while ensuring compliance with company policies and procedures, and coordinating with the Payment Transformation team to transition fee-for-service arrangements to value-based care. This role will also oversee complex projects related to provider contracts, reimbursement methods, documentation and amendments, and participate in internal workgroups and committees, ensuring compliance and advising on business strategies. ESSENTIAL FUNCTIONS: Contract Development and Negotiation Serves as a consultant and subject matter expert (SME) in contracting and...

CareFirst BlueCross BlueShield Resp & Qualifications PURPOSE: This role is primarily remote with occasional in office team meetings. Provides advanced expertise in developing and maintaining reports, dashboards and data repositories to meet the business intelligence requirements of the organization. Provides data, analysis and requirements in support of a complex reporting and analytics environment. Serves as a subject matter expert in projects related to the data analysis and reporting tools technology. ESSENTIAL FUNCTIONS: Fulfill complex regulatory reporting requirements by understanding the external request and working with IT and business resources to provide CareFirst data into mandated reporting within required timelines. Develops client/customer presentations and reports with a high degree of a more complex nature. May develop innovative best practices and industry bench marking for process measurement and identify indicators for future improvement...

WIN Waste Innovations WIN Waste Innovations is looking for a Maintenance Supervisor is primarily responsible for the day-to-day assignments of the maintenance department based on operational requests and requirements. They will be responsible for the safe, proper, and efficient maintenance of the facility in accordance with company policies and standards, under the direction of the Maintenance Manager. They will manage and coordinate maintenance activities to include but not be limited to installing, inspecting, testing, repairing, adjusting, and calibrating all plant equipment and instrumentation. Responsibilities: Plans, assigns, and supervises the work of the maintenance department during daily operations Responsible reviewing and ensuring all operating and emergency procedures are being complied with in the Maintenance department Makes daily inspections of plant machinery and equipment; inspects ongoing activities for safety and environmental compliance, and for...

CareFirst BlueCross BlueShield Resp & Qualifications PURPOSE: The Inpatient Management Onsite Care Management Supervisor will direct and coordinate the activities of Onsite Care Management staff, Onsite Clinical Navigators and/or other Registered Nursing roles embedded at a partnering hospital. This role will assist leadership with the development and review of Care Management standards, program criteria, policies, and procedures to ensure quality of care and manage healthcare costs. The incumbent will function as a liaison working onsite at partner hospitals up to 5 days a week. Based on hospital assignments and admission volumes on a week-to-week basis, management may occasionally approve the onsite care management supervisor to perform limited functions telephonically, at its sole discretion.The candidate may also be required to come to the CareFirst office location periodically for meetings, training, or other business-related activities. The candidate's primary...

CareFirst BlueCross BlueShield Resp & Qualifications PURPOSE: The Quality Manager leads a team of associates responsible for defining, measuring, analyzing, and evaluating population health, while prioritizing, developing, and operationalizing innovative initiatives to improve the quality of care and experience, resulting in industry-leading outcomes at a population level. ESSENTIAL FUNCTIONS: Manages, develops, and leads a team in a matrixed organization environment. Monitors, measures, and ensures compliance with accreditation requirements, quality performance methodologies, and applicable state, local, and federal regulations. Formulates and implements the enterprise strategy for population health, quality, and member experience improvement. Drives the progress and completion of innovative initiatives and evaluates their effectiveness. SUPERVISORY RESPONSIBILITY: This position manages people. QUALIFICATIONS: Education Level: Bachelor's Degree in...

Aledade In this role you will manage the delivery of interface projects aiming to obtain healthcare data from a wide variety of Practice Management systems, EHR systems, HIE vendors, hospital systems, national aggregator, or interoperability network to enable our partner practices to use key functionality in Aledade's population health platform. The manager will provide strategic planning and roadmap of the data integration portfolio. The manager will be responsible for coordinating and prioritizing the day-to-day activities of the integration project management team as well as collaborating with internal teams and external vendors. The manager will lead a team or assist the Director to stand up a new team. Primary Duties 1. Maintaining continuous alignment of program scope with strategic business objectives. Make recommendations to modify program and prioritization to enhance effectiveness toward the business result or strategic intent A. Create program roadmap B. Manage...