Jobs at Healthfirst

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QA Auditor

Healthfirst - New York, NY

Minimum Qualifications: Experience working in a Call CenterExperience in Microsoft Office suite of applications including Excel (formatting formulas, managing data, and filtering results), Word (creating and editing documents), PowerPoint (creating and editing presentations).High School Diploma or GED from an accredited institutionPreferre...

Actuarial Analyst

Healthfirst - New York, NY

The Actuarial Analyst for Valuations is responsible for assisting in performing valuations, producing IBNR models, analyzing experience, preparing trend reports, and assisting with other tasks on both a regular and ad hoc basis.Construct monthly IBNR models using paid claim and membership data. Run, modify, and create data queries to produce supplemental reports. Initiate, oversee, and verify i...

QA Auditor, Claims

Healthfirst - New York, NY

The Quality Assurance Auditor is responsible for performing Internal Quality Assurance Audits of Operational processes for internal employees and outsourced vendors to ensure compliance with policies, procedures and quality standards. The incumbent will investigate, audit, conduct root cause analysis, handle processing of determinations, track and trend findings. The individual at this...

AR Analyst

Healthfirst - New York, NY

The Accounts Receivable Analyst (ARA) responds to member inquiries through our business process and customer relationship management systems. The ARA performs all account analysis and loads all payment information into the Healthfirst Managed Healthcare System (MHS). The ARA evaluates active member status to ensure payments are received and processed into the individual member account ensuring ...

Nutrition Specialist, Long Term Care

Healthfirst - New York, NY

The Long Term Care Nutrition Specialist supports the Nutrition Team Registered Dietitians by arranging qualified services for their members. The LTC Nutrition Specialist is actively involved in the coordination of all covered services. This position reports to the Senior Manager and/or Manager of the Nutrition Team.Complete new and discontinued service authorizations as directed by Regi...

Business Analyst

Healthfirst - Lake Mary, FL

The Business Analyst is responsible for reporting, business process review and data analysis relating to activities ensuring operational effectiveness. The BA will assist management by developing and maintaining reporting tool and processes, querying and analyzing data, identifying root causes, recommending and supporting decision making. The BA owns project goals by developing project plans, e...

Enterprise Data Architect

Healthfirst - Lake Mary, FL

The Enterprise Data Architect is responsible for aligning the future state enterprise information architecture with the corporate strategy. This role collaborates with enterprise architects, partners with solution architects and subject matter experts from cross-functional Business and IT areas. This position collaborates with several Business and IT roles supporting data, analytics, and data i...

Data Analyst

Healthfirst - Lake Mary, FL

Position Summary:The Data Analyst is responsible for managing assigned data entities across a specified portion of the enterprise and ensuring high levels of data analysis, quality, integrity, availability, trustworthiness and data security. This role is responsible for establishing consistent data definitions, maintaining business and technical rules, and monitoring and auditing data quali...

Clinical Care Coordinator

Healthfirst - New York, NY

The Clinical Care Coordinator is responsible for conducting outreach to Healthfirst members who have selected a primary care provider (PCP) at assigned hospital center and assigned satellite primary care clinics, to encourage compliance with primary and preventive health maintenance visits and to educate members on how to access services within the assigned hospital center and Healthfirst netwo...

Clinical Care Coordinator

Healthfirst - United States of America

The Clinical Care Coordinator is responsible for conducting outreach to Healthfirst members who have selected a primary care provider (PCP) at assigned hospital center and assigned satellite primary care clinics, to encourage compliance with primary and preventive health maintenance visits and to educate members on how to access services within the assigned hospital center and Healthfirst netwo...

Care Manager, Onsite at Hospital - Bronx

Healthfirst - New York, NY

The Field Care Manager performs assessments and reviews discharge planning for our members. This position has face-to-face member contact depending on the hospital's limitations and stipulations. The Field Care Manager collaborates with hospital clinicians and a care management team (which may include RN's, Social Workers, and Coordinators) to evaluate and treat members and provides education a...

Sr Mgr Customer Experience

Healthfirst - New York, NY

This role will report to the Director of Customer Experience and be instrumental in defining and building a world-class customer experience center of excellence. As part of the Customer Experience team, you will have the opportunity to shape and influence the experience direction of Healthfirst by creating and executing initiatives that will build momentum and accelerate a cultural change acros...

A&G Coord

Healthfirst - Lake Mary, FL

The Appeals and Grievances Provider Claims Coordinator is responsible for receiving, investigating and responding in writing, to participating and non-participating provider non-clinical claims appeals. These include disputes about denied claims, claims payments, and adjusted claims which have previously undergone the claims department review and reconsideration process. The appeals may be rela...

Case Manager, Utilization Management (Telecommuter)

Healthfirst - New York, NY

The Case Manager, Utilization Management coordinates the care plan for assigned members and conducts pre-certification, concurrent review, discharge planning, and case management as assigned. The Case Manager, Utilization Management is also responsible for efficient utilization of health services and optimal health outcomes for members, as well as meeting designated quality metrics.- Provide...

Care Manager

Healthfirst - United States of America

The Care Manager plans and manages behavioral and/or physical care with members and their beneficiaries and works with clinicians and health care team members. The Care Manager facilitates care and medical attention and addresses identified member needs across the continuum of care. The Care Manager is responsible for applying care management principles when engaging members and addressing coor...