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

Implement and manage Azure database services, ensuring high availability, disaster recovery, and performance optimization in line with best practices. Utilize Azure DevOps for continuous integration and delivery pipelines, infrastructure as code, and proactive monitoring and alerting of database environments. Serve as a Site Reliability Engineer (SRE) focusing on the reli

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

Work incoming requests from end users via telephone, e mail and the ticketing system in a courteous manner. Log all Service Desk interactions in our ticketing system. Daily review of open or escalated tickets; review/update/follow up/close open or escalate tickets. Work cooperatively with fellow IT members to create and maintain a knowledge base for systems use and develo

Supervision of call center talent acquisition team. Ensures talent acquisition team is meeting goals and objectives for filling operational and call center positions. Collaborates with and provides direction and coaching to leadership and department managers to understand required knowledge, skills, and abilities for open positions. Oversees recruitment strategies for ope

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