The Manager of Risk Adjustment and Trend Analytics is a key member of the Finance management team. Under supervision of the V.P of Financial Planning and Performance Analysis, the Manager oversees risk adjustment analysis primarily related to the MassHealth Medicaid and New Hampshire Medicaid lines of business, directly impacting and improving the revenue for these produc

The Manager of Behavioral Health Payment Strategy will lead policy development and performance initiatives to align with the organization's corporate strategy and contractual/compliance requirements posed by regulatory oversight agencies, including CMS, MassHealth, NH Medicaid, and the DOI. This individual will ensure payment policy and payment system compliance and accur

The Staff Accountant is a key member of the Accounting team and works closely with all members of the team in meeting close deadlines, working with various general ledger modules, preparing account reconciliations, and supporting internal and external audits. Positive and team oriented work ethic is critical to this role. Our Investment in You Full time remote work Compet

Develops, maintains and manages all plan fee schedules and code pricing. Monitors multi state regulations including DHHS, EOHHS, and CMS websites, listservs and other sources to identify existing payment practice and proposed changes. Determine the scope and impact of the change on Plan operations and seek to implement changes as necessary. Business owner in managing soft

The Operations Trainer develops a wide variety of training programs and materials to support the Claims, Call Center, and Enrollment teams. The trainer researches, develops, and facilitates in house training courses for new and existing employees. Develops training competency tools that will ensure the quality, consistency and timeliness of department activities. Maintain

The Culture and Engagement Program Manager is responsible for developing strategies to improve engagement, and manage programs and processes designed to foster it, such as the employee engagement survey, employee recognition, training and development, wellness and other activities aimed at creating a positive workplace environment. Implement and drive an integrated cultur

Generates and/or distributes member documents and files Data entry of confidential member information into multiple databases Generates simple reports for care management team Initiates and follows up on requests for provider information Assists in scheduling Primary Care Team meetings and exchanging information, facilitating communication among team members as needed Ass

The Business Encounter Data Analyst is responsible for compiling and analyzing encounter data and understanding the claim impact of changes and decision to the business process to ensure that CMS and State Service Level Agreements (SLAs) are achieved. This individual will support the encounter data lifecycle process working closely with business and technical resources as

Monitors actual FCR and NPS performance against corporate targets; presents findings; proactively investigates and communicates explanations for variation and conducts root cause analysis. Provides critical data analysis and recommendations to establish corporate goals related to FCR and NPS. Conducts deep analysis on data related to FCR and NPS, reviews member surveys, l

Reporting to the Manager of Consumer Sales and Performance, the Broker Account Executive is a licensed sales professional with experience in Medicare/Medicare Advantage and individual ACA markets and is responsible for building and managing relationships with WellSense's contracted brokers. The Broker Account Executive provides strategy support and product training broker