Develop and maintain software applications. Design, development, maintenance, and troubleshooting of software applications. Performs routine programming assignments under Manager's supervision. Develops an understanding of assigned application and internal customer area, standards and techniques, and general business knowledge. Demonstrates understanding of departmental p

Researches turn around time utilizing the Medical Necessity In Process Report. Checks with MNA staff to see if the Medical Necessity Review Form (MNR Form) is in house. If so, advises staff to process the MNR Form as priority. Reprint MNR Forms that cannot be located. Calls practitioner to request re faxing of MNR Forms as necessary. Documents all phone calls in ASH propr

Enable teams to research, design, develop, and maintain existing and new websites and components Monitor and analyze team progress and results within their product teams and adjust assigned resources as necessary to maintain user and engineering goals and milestones. Provide guidance and oversight in project planning, technical design, estimating and development schedules

Leading a portion of a growing DevSecOps engineering team. Develops project plans, specifying goals, strategies, resource allocation, and scheduling. Coordinates activities of DevSecOps engineers to ensure goal achievement within identified timeframes. Researches and evaluates technology and processes; makes recommendations to improve team performance, productivity, and s

Coordinates intake, navigation services, and administrative support for Virtual Physical Therapy and Fall Prevention program Receives and responds to telephone calls, greeting members with a courteous, welcoming manner and offering an introduction and pertinent information. Utilizes defined criteria to determine member qualification for applicable programs. Gathers detail

Receives and responds to telephone calls from members, and health plans/employer groups. Demonstrates knowledge and understanding of all ASH products and programs through consistent proficiency in quality, quantity, and responsiveness. Responsive to customer contacts in a professional, accurate, timely and courteous manner. Ascertains the nature of the contact and records

Answer incoming calls in a professional, accurate, timely and courteous manner. Ascertain the nature of the call and record information in the Communication Log. Look up member information using proprietary ASH systems and provide information to the caller. Forward logs requiring further research to the appropriate department. Transfer callers to the appropriate queue if

Responsible for researching and the tracking and implementation of privacy requirements related to laws, regulations, accreditation, and industry best practices involving privacy and impacting ASH's operations. Monitors new laws and regulations impacting the Privacy Office. Confers as needed with Regulatory and Program Compliance on such developments. Presents new privacy

Outreach and educate contracted practitioners to ensure compliance is met. Conduct regular Access to Care Surveys to ensure compliance with regulatory and health plan requirements. Outreach to practitioner network of practitioners who have not validated their demographics in order to meet regulatory requirements. Conduct audit to confirm current directory listing informat

Interfaces with various clinical practitioner types to promote ASH and to execute practitioner contracts for key health plan clients to support relationships and to provide delivery system updates. Maintain ongoing focus for productivity in a fast paced environment and meets deadlines in an environment where priorities may change. Ability to display effective presentation

Support of medical necessity review determinations. Perform outreach calls to practitioners and clinical practices for network and non network therapy practitioners. Determine and obtain appropriate clinical assessment for submitted diagnosis codes. Clarify provider requests, providing education on ASH's submission process, forms, and available resources. Facilitate clini

Reconciles, resolves, and researches 2 step claims and payments to ASH. Receives and sorts incoming mail including paper EOBs, faxes, Interoffice Mail, and Health Plan letters. Downloads electronic EOBs from Health Plan Portals. Count and scan EOBs and Health plan letters for distribution and track counts into daily inventory. Manually reconciles claims for payment from H

Routine treasury and corporate finance support. Supports Sr. Director, Treasury & Tax with all treasury and tax related activities. Manage banking relationships. Determine the daily cash position and manage account transfers, wire transfers and ACH transactions. Prepare quarterly debt compliance package. Prepare short term and long term cash forecasts and analyses. Suppor

Provides support with managing regulatory compliance concerns for projects as assigned by management. This may include assuming responsibility, with supervision by management, for a limited number of specific states or areas of compliance (e.g., federal regulations or Compliance Office concerns). Researches, communicates, and coordinates regulatory compliance issues under

Manage the medical necessity review of acupuncture services. Performs medical necessity review of requested services from network and non network Acupuncture practitioners. Conduct timely, accurate, and (inter and intra ) consistent reviews in order to verify and approve medically/clinically necessary and appropriate care and services for our health plan members. Effectiv