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This role is responsible to assist the Community Relations Team as needed at health fairs, expos and other various community events throughout the state. Assist with staffing table at events by handing out trinkets and handouts. Assist with set up and clean up at events; including moving boxes and tables, setting up/take down tent, etc. Engage event visitors and encourage UCare game participati
Posted 1 day ago
This position is responsible to lead the processing of EDI provider rejections and monthly DHS and CMS provider encounter errors. Establish and maintain working relationships with providers and Clearinghouses; as well as establish and maintain a relationship with DHS to ensure encounters are reviewed and resubmitted accordingly. Collaborate with internal and third party technical contacts to test
Posted 1 day ago
The Utilization Review Specialist's primary responsibilities are to evaluate member specific clinical information against objective, standardized criteria to determine medical necessity, appropriateness and efficiency of specific services the organization has targeted for prior authorization. Specific duties and responsibilities include Complete the continuum of utilization review processes within
Posted 4 days ago
This position is responsible to investigate and coordinate activities for resolutions of appeal, grievance and quality of care cases for Medicaid, Medicare, Medicare Part D, Special Needs and Exchange plan members. Provide verbal and written communication to members and providers regarding the investigation of appeal, grievance and quality of care cases. Prioritize and organize work in order to me
Posted 6 days ago
This position is responsible to translate UCare's business requirements into functional requirements in order to configure AMISYS to support benefit administration, authorization requirements and claims adjudication. Analyze new business plans and changes to existing business plans in order to establish the appropriate benefit structure needed. Works with other departments to ensure smooth impleme
Posted 6 days ago
This position is accountable for supporting the Customer Service Contact Center through creation and maintenance of workforce capacity models, forecasting workload, and leading the planning & real time monitoring of contact center performance. The analyst is expected to identify, analyze and plan for volume drivers and other impacts for optimal performance. Develop reports and analyze data from mu
Posted 8 days ago
This position is responsible for to create and maintain technical requirements and system design of EDI transaction solutions that follow established software development standards and policies. Firm understanding of ANSII ASC X12 file standards with emphasis on the healthcare related 837P, 837I, 835, and 834 transaction sets. Responsible for collaborating with EDI Operations Analyst, software eng
Posted 14 days ago
This position is responsible to design, build and expand the company's utilization of BizTalk with a focus on Service Oriented Architecture (SOA). This position will support the integration and development efforts for creating SOA applications to support consumerism and the Health Care Exchange. Ensure best practice for Enterprise Application Integration patterns are implemented. Analyze, design,
Posted 16 days ago
Research, resolve, examine and process paper and/or electronic claims submitted for payment. Interact with internal customers to obtain needed information for claim processing. Process claims reviewing Policies and Procedures, Coordination of Benefits, and applying appropriate plan provisions, CMS Regulations and DHS guidelines for payment determination. Ensure accurate and timely processing of c
Posted 19 days ago
This position is responsible to apply knowledge of UCare's business, products, members and operations to accurately and effectively fulfill member service requests and inquiries. Ensure adherence to policies and procedures and meet service level expectations by following established guidelines and standards. Achieve fluency in at least one core product or service line. Answer, resolve, track and
Posted 19 days ago
UCare
- Minneapolis, MN
This position is responsible to support the team by providing daily business support for EDI activities, research questions and issue resolution; maintaining implementation companion guides; supporting the development of interfaces; performing data audits to validate information exchanged with the providers; and running reports as needed. The analyst will also be responsible to collaborate with bu
Posted 21 days ago
UCare
- Minneapolis, MN
This position is responsible to plan, document, coordinate, architect, and lead all activities related to the standards and integration of software programs, applications, and third party solutions as required to meet business requirements of the organization. This individual is also responsible for developing and maintaining an application integration architecture blueprint for the organization.
Posted 26 days ago
UCare
- Minneapolis, MN
This position is responsible to support to the UCare organization via phone, remote, and onsite support. Provide real time application or hardware support to eliminate or avoid business impact. Troubleshoot, diagnose and resolve incidents/problems and outages of production environments. Respond promptly to incidents and escalate when appropriate. Triage Service Management incidents and requests in
Posted 26 days ago
This position is responsible to provide leadership and direction to Enterprise Data Services team. Manage daily operations of leading creative approaches to problem solving, as well as the development of quality deliverables, supporting Enterprise Data Architecture strategic initiatives. Must be able to build relationships and trust with peers, business partners and team staff members. Responsible
Posted 28 days ago
UCare
- Minneapolis, MN
This position is responsible to design, develop and implement technical quality audit programs and monitor accuracy, compliance and effectiveness of production across Billing and Enrollment and other impacted areas such as Customer Services, Sales and Product. Develop, monitor and maintain Billing and Enrollment policies and procedures and step by steps in compliance with regulatory requirements a
Posted 1 month ago
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