2 jobs found in shrewsbury

Type:  Full-Time Posted:  02/10/2023 Category:  Human Resources Job Number : 2023-42705 Department:  ForHealth Consulting - Process Impr & Project Mgmt OPS - W407619 Job Type:  Perdiem POSITION SUMMARY: The Project Management Consultant provides professional assistance, project management, recommendations on business need and performs operational management work covering a broad range of activities. This position is responsible for providing subject matter expertise in areas including project scope definition, risk identification, project methodology, resource allocation, facilitation, and other areas of expertise based on established project management techniques. The position is also responsible for providing project coordination across multiple businesses units, analytical assessment of business problems, monitoring organizational performance, and identification of risk to operational plans. Develops various ad hoc...

Type:  Full-Time Posted:  02/10/2023 Category:  Human Resources;  Business and Financial Services Job Number : 2023-42686 Department:  ForHealth Consulting - Justice & Health Equity - W835110 Job Type:  Full-Time Under the general direction of the Business Operations Manager, or designee, the Claims Quality Assurance Auditor (Auditor) is responsible for ensuring the integrity of invoice adjudication and outside medical payments in compliance with standard policies, procedures, and guidelines, as well as contractual agreements. The Auditor will verify the accuracy of medical pricing by ensuring accurate CPT, HCPC, ICD-10 and DRG coding. The Auditor will interpret plan contract language and apply appropriate benefit coverages based on the contract provisions while meeting production and quality standards as defined by management. This role will track changes within contractual agreements and ensure that invoicing,...