Jobs at Healthfirst
9,756 open positions
Data Engineer
Company: Healthfirst, Inc
Location: New York City, NY
Posted Dec 07, 2024
The Data Engineer is responsible for data acquisition strategies and integration scripting and tools data migrations conversions purging and backups. They work with various stakeholders to understand business requirements and support data architecture. The Data Engineer authors artifacts defining standards and definitions for storing processing and moving data, and maps details to business processes, nonfunctional characteristics, QA criteria, and technical enablement. They continuously think through the needs of the business to support efficient and error-free processes.
Billing Operations Analyst
Company: Healthfirst, Inc
Location: New York City, NY
Posted Dec 10, 2024
The Billing Operations Analyst is responsible for generating all State premium revenue across all product lines and ensuring operational effectiveness. The individual will coordinate completion and submission to the New York State Department of Health with IT for State revenue and ensure all supporting revenue and remittance data has been loaded to the data warehouse for reconciliation and recording. The duties include generating and reviewing State billing files, ensuring State billing files are loaded to the data warehouse following completion of the billing process, identifying and billing kick events, preparing monthly Child Health Plus CHP State vouchers, reviewing and creating all General Ledger GL reports monthly, ensuring supporting revenue is loaded to the data warehouse monthly, ensuring State remittance files are loaded weekly, researching and rebilling denied claims, submitting refunds to the Department of Health for Retro Disenrollment VOID reports, and additional duties as assigned.
Episodic Support Coordinator UM/CM
Company: Healthfirst, Inc
Location: Remote
Posted Dec 11, 2024
The Support Coordinator is responsible for assisting carecase managers with nonclinical activities such as creating cases and events, managing authorizations, providing telephonic outreach to members, providers, and community-based organizations, handling member mailings, faxing clinical requests and Individual Health Care Plans, and more. The role requires excellent customer service skills, managing a large volume of tasks, and adhering to HIPAA requirements.
Senior Manager, Migrations (ETL)
Company: Healthfirst, Inc
Location: New York City, NY
Posted Dec 07, 2024
The text describes a Senior Manager role for a Migration team, responsible for overseeing migration initiatives, leading a team, managing project timelines, and ensuring efficient, secure, and minimal disruption to business operations. The role requires extensive experience in Agile methodologies, leading technical teams, and having a strong technical background in systems architecture, databases, and cloud technologies. The company is an equal opportunity employer and offers a competitive compensation and benefits package.
Team Lead Workforce Effectiveness
Company: Healthfirst, Inc
Location: Other US Location
Posted Dec 05, 2024
The position is a Hybrid FL or Hybrid NY role, responsible for overseeing time and attendance planning, scheduling, and mission control for real-time analytics. The team lead ensures operational excellence and adherence to SLA across contact center operations and other business segments. They coordinate across various units, aligning strategies with immediate and long-term business objectives.
Mgr Product Mgmt & Strategy
Company: Healthfirst, Inc
Location: New York City, NY
Posted Dec 17, 2024
The Manager of Product Management and Strategy is responsible for developing and executing a market growth strategy that supports profitable growth across the senior market portfolio. The role requires identifying areas of profitable growth opportunity, improving the membership experience, and managing competitive intelligence. The manager should have a Bachelor's degree and extensive experience with Medicare products. Preferred qualifications include a Graduate degree in public health, public policy, or business administration.
Remote UM Pharmacy Technician
Company: Healthfirst
Location: Remote
Posted Dec 19, 2024
The UM Pharmacy Technician role involves reviewing and approving prior authorization requests for medications under medical benefits. This position requires strong communication skills, rapport building with provider offices, and decision notifications to members and providers. The role is part of a multidisciplinary team, working closely with providers, pharmacists, and medical directors. Minimum qualifications include a high school diploma, pharmacy technician certification, and prior authorization review experience. Preferred qualifications include fluency in Chinese, Spanish, or Russian, critical thinking skills, and knowledge of specialty pharmaceuticals and billing practices.
Sr. Workforce Effectiveness Data Analyst
Company: Healthfirst, Inc
Location: Remote
Posted Dec 05, 2024
The Senior Strategic Data Analyst is responsible for promoting a data-driven culture within Healthfirst Operations. They have a deep understanding of the health insurance industry and can identify opportunities for technology and analytics to improve efficiency. They play an integral role in department initiatives by leveraging analytics to provide insights that support key decisions.
Performance Support Specialist - Bilingual Vietnamese
Company: Healthfirst, Inc
Location: New York City, NY
Posted Dec 05, 2024
The Performance Support Specialist role involves assisting in resolving customer complaints, reviewing nonurgent complaints, and providing determinations while maintaining a tracking system. The role requires excellent communication skills, healthcare industry experience, and proficiency in Microsoft suite of applications. The company is an equal opportunity employer and offers a competitive compensation and benefits package.
Director, Medicare Sales - Asian Market
Company: Healthfirst
Location: New York, NY
Posted Dec 19, 2024
The Director, Medicare Sales - Asian Market is tasked with developing and implementing marketing strategies for the Medicare division, focusing on lead generation, sales, and retention goals. This role involves staffing, planning, goal setting, training, and managing the Medicare sales team within a specified geographic area. Key responsibilities include directing prospect and sales activities for Medicare products, developing sales and marketing strategies, and ensuring interpersonal effectiveness both within and outside the organization. The ideal candidate should possess strong relationship-building skills, superior communication abilities, strategic thinking, and a drive to meet or exceed sales goals. Additional duties include coaching and mentoring staff, maintaining compliance with CMS/corporate policies, and recruiting, hiring, and training high-performing employees.
VP Associate General Counsel
Company: Healthfirst, Inc
Location: New York City, NY
Posted Dec 05, 2024
The VP Associate General Counsel position at Healthfirst Inc and its subsidiaries involves providing legal advice and support to various departments, working a hybrid work schedule, and maintaining knowledge of laws and regulations affecting managed care companies. The role requires strong communication skills, legal proficiency, and experience in provider contracting and risk transaction regulatory frameworks.
Appeals and Grievances Clinical Specialist - RN or LPN - 100% Remote
Company: Healthfirst
Location: Remote
Posted Dec 19, 2024
The A&G Clinical Specialist role at Healthfirst involves managing member and provider complaints, grievances, and appeals related to clinical and non-clinical services. The specialist is responsible for case development and resolution, ensuring compliance with federal and state regulations. Duties include researching issues, interpreting regulations, updating file documentation, and communicating effectively with colleagues. The role requires managing large caseloads in a fast-paced environment and preparing cases for review and appeals. Minimum qualifications include an RN, LPN, or Dental Hygienist license, while preferred qualifications include a Bachelor's degree, experience in clinical practice, and familiarity with Utilization Review Guidelines and care management systems.