PRINCIPAL RESPONSIBILITIES. . Under the direct supervision of a Claims Processing Supervisor and the general direction of the Manager, Claims Production, this position is primarily responsible for the accurate review, entry and processing of claims received for payment by Alameda Alliance for Health (AAH). . Principal responsibilities include. Research claims for completion and appropriateness. Review and handle rejected claims as necessary. Eval...
PRINCIPAL RESPONSIBILITIES. . The BH Navigator will assist with utilization management of services and monitor continuously for quality and accuracy. This role is responsible for processing and monitoring the authorization process and corresponding documentation. Under the general direction of the Behavioral Health Supervisor, this position will help to plan, organize, and implement Alliance Behavioral Health program. The BH Navigator will supp...
PRINCIPAL RESPONSIBILITIES. Under general direction of the Director, Long Term Services and Supports (LTSS) and working in cooperation with other departments, such as Utilization Management and Case management. the LTSS Nurse is responsible for evaluating the clinical information submitted to perform clinical reviews for requests for Long Term Care (LTC) and Community Supports (CS) requests as needed. This role utilizes the applicable clinical pr...
PRINCIPAL RESPONSIBILITIES. . The Director of Medicare Compliance is responsible for developing, implementing, and overseeing all activities related to ensuring compliance with Medicare regulations, CMS requirements, and applicable federal laws governing Medicare Advantage and Part D programs. This position serves as the subject matter expert for Medicare compliance and reports directly to the Chief Compliance Officer & Chief Privacy Officer (CCO...
PRINCIPAL RESPONSIBILITIES. . Under the general supervision of the Director, Applications Management, Quality & Process Improvement, the Business Process Automation Developer performs complex business process automation and data analysis with internal customers to gather business requirements for use in identifying innovative technology solutions and supporting system configuration to meet business needs. Business Process Automation Developer wil...
PRINCIPAL RESPONSIBILITIES. . Under general direction of the Chief Financial Officer, this position is responsible for developing, implementing, and maintaining the Alliance’s accounting policies, procedures and practices and for the day-to-day management of the Alliance’s general accounting functions. Overall responsibilities include designing and maintaining an accounting system which records the necessary financial data for budgeting and finan...
PRINCIPAL RESPONSIBILITIES. . Under the direction of the Director, Housing and Community Services Program (HCSP), the Manager, Community Health Worker Program (Manager, CHW Program) serves as one of Alameda Alliance for Health’s (Alliance) key champions for implementing and integrating health and wellness strategies that aim to deliver high-quality, equitable and accessible preventative health care services to Alliance members. The Manager of the...
Description. PRINCIPLE RESPONSIBILITIES. Under the general direction of the Manager, Marketing, Communications, and Branding, and in conjunction with the Curriculum Designer, Medicare Programs, the Trainer, Medicare Programs is responsible for designing, developing, and delivering comprehensive trainings for the Alliance's Medicare Advantage Dual Eligible Special Needs Plan (D-SNP) product for internal staff and external providers and stakeholder...
PRINCIPAL RESPONSIBILITIES. Member Services Representatives (MSR) are the first point of contact for our members’ primary contact with the Alliance for both routine and complex member issues with the goal of delivering excellent customer service to our customers. The position is responsible for answering a high volume of inbound and outbound calls in a timely manner. Respond to all communications coming into Member Services in the form of email,...
Description. PRINCIPAL RESPONSIBILITIES. The EDI Analyst will support the team by providing daily technical 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 EDI Analyst will facilitate the process of onboarding providers for EDI cl...
PRINCIPAL RESPONSIBILITIES. Member Services Representatives (MSR) are the first point of contact for our members’ primary contact with the Alliance for both routine and complex member issues with the goal of delivering excellent customer service to our customers. The position is responsible for answering a high volume of inbound and outbound calls in a timely manner. Respond to all communications coming into Member Services in the form of email,...
PRINCIPAL RESPONSIBILITIES. Under the direct supervision of the Claims Processing Supervisor and the general direction of the Manager, Claims Production, this position is responsible for the accurate review, entry and processing of all claims received for payment by AAH. . Principal responsibilities include. Research claims for completion and appropriateness. Review and handle rejected claims as necessary. Evaluate HealthSuite error screen and ba...
