Overview The Market Conduct Examiner (MCE) performs highly complex work involving planning and coordinating market conduct examinations of insurers. Market conduct examinations are done under the direction of the Director of Market Regulation (Director) and require significant interaction with management level staff of insurer organizations. The MCE is responsible for Ass

Location Wichita, KS (Onsite) Key Accountabilities Monitor Spirit for financial compliance with the U.S. Government rules and regulations Responsible for disseminating current policy and providing advice, ensuring effective EVM implementation on new contracts, analysis of contractor performance reports, facilitating Integrated Baseline Review (IBR), risk assessments, supp

Bring your ideas. Make history. BNY Mellon offers an exciting array of future forward careers at the intersection of business, finance, and technology. We are one of the world's top asset management and banking firms that manages trillions of dollars in assets, custody and/or administration. Known as the "bank of banks" 97% of the world's top banks work with us as we lead

Under direction of both the Director and CDI Manager, the Clinical Documentation Specialist independently prioritizes and performs assigned duties and tasks. Clinical Documentation Specialists are responsible and accountable for the day to day management and success of the Continuous Documentation Improvement Project to include all modalities, acting as a liaison with spe

The essential duties and responsibilities (including but not limited to) Reviews, processes and audits the medical necessity for each patient chemotherapy treatment and documentation of regimen relative to pathway adherence. Communicates with nursing and medical staff to inform them of any restrictions or special requirements in accordance with particular insurance plans.

The Highlights The SEVIS Compliance Analyst is responsible for applying federal regulatory parameters to determine whether non immigrant student and exchange faculty members are compliant with Department of Homeland Security (DHS) regulations, as part of the mandatory SEVIS reporting responsibilities of the University. The ISS must meet continuous non negotiable Student a

Assist in end to end behavioral health provider claims and help enhance call quality Assist in efforts to enhance ease of use of online provider portal and future services enhancements Contribute to design and implementation of programs that build / nurture positive relationships between the health plan, providers and practice managers Support development and management o

Associate, Anti Money Laundering/Prevention/KYC Representative II Bring your ideas. Make history. BNY Mellon offers an exciting array of future forward careers at the intersection of business, finance, and technology. We are one of the world's top asset management and banking firms that manages trillions of dollars in assets, custody and/or administration. Known as the "b

The Principal IT Regulatory Analyst recommends, develops, and implements IT regulatory strategy and rate case deliverables, and drives supporting processes and tools. This position supports all CPUC and FERC rate cases and proceedings (GRC, TO, RAMP), the IT component of separately filed rate cases (e.g. WGSC), and compliance with all regulatory directives and stakeholder

1) to implement a governance model at a level under the VP of Governance, Risk and Opportunities, and serve as the second line of defense for the Business Unit. And 2) to drive the implementation of risk and opportunities processes and tools during project execution, as well as for the analysis of the risk and opportunities information to maintain visibility of top risks

Educate Providers to ensure they have the tools they need to meet Quality, Risk adjustment, growth (as appropriate) and Total Medical Cost goals per business development plans Ensures Providers have in depth understanding of WellMed Model of Care to include, but not limited to, contractual obligations, program incentives and patient care best practices Conduct detailed an

Coordinates intake of cases on new and established assignments to expedite the Care Coordination process by facilitating the medical review process, verifying health plan eligibility, obtaining and assessing preliminary clinical and non clinical data or needed additional data, determining appropriate case type, and triaging to the appropriate resource. Initiates and advan

Under direction of both the Director and CDI Manager, the Clinical Documentation Specialist independently prioritizes and performs assigned duties and tasks. Clinical Documentation Specialists are responsible and accountable for the day to day management and success of the Continuous Documentation Improvement Project to include all modalities, acting as a liaison with spe

Fraud Detection Analyze fraud events for suspicious activity. Execute fraud prevention measures to reduce loss exposure. Track actions and financial transactions in case management system. Administrative Responsibilities Assign and track daily work events to the team. Complete weekly/monthly recurring reports. Complete additional assignments as requested. Act as a back up

Contribute to design and implementation of programs that build/nurture positive relationships between the health plan, providers and practice managers Expertise in physician/facility/ancillary contract reimbursement methodologies Lead cross functional teams and drive the team to successfully complete the objectives Engage with local provider organizations to support, augm