To perform this job successfully, an individual must be able to perform each essential duty listed below satisfactorily. Business Systems Analyst I Project and task management for small scale projects including facilitate stakeholder and project team meetings, track actionable items, send regular project communications to team members and stakeholders, and escalate identi

To perform this job successfully, an individual must be able to perform each essential duty listed below satisfactorily. Develop, implement and manage all UM processes for continuous and sustained compliance with all applicable state, federal and NCQA regulatory requirements, SCFHP policies and procedures and general business requirements for all lines of business. Develo

To perform this job successfully, an individual must be able to satisfactorily perform each essential duty listed below. Read, interpret and implement all regulatory guidance related to the handling of appeals and grievances, including the Medicare Managed Care Manual, State and Federal contracts , APLs,DPLs and other memos that provide direction. Demonstrate a solid unde

To perform this job successfully, an individual must be able to satisfactorily perform each essential duty listed below. Responsible for revenue and cost reconciliation activities using capitation invoices, eligibility files, claims and expense data and other relevant reports. Design and prepare reports that analyze the financial outcome of programs and make recommendatio