Performs daily System Engineering tasks. Develop and implement automation solutions for system operations, leveraging coding best practices and industry standards to enhance efficiency, reliability, and scalability. Work with System Administrators to develop skill level and knowledge in our environment. Lead and plan tasks required for upgrades, migrations, optimizations,

Supervises benefits team engaged in the above functions providing work direction; performance reviews; salary and promotion recommendations; hiring; termination and supports staff in the accomplishment of assigned objectives; projects and goals. Participates in a variety of managerial responsibilities such as (but not limited to) serving on work groups; performing special

Outreach and educate contracted practitioners to ensure compliance is met. Conduct regular Access to Care Surveys to ensure compliance with regulatory and health plan requirements. Outreach to practitioner network of practitioners who have not validated their demographics in order to meet regulatory requirements. Conduct audit to confirm current directory listing informat

Respond to and resolve practitioner inquiries received via the Provider Relations and Credentialing queue. Assists practitioners, staff, and clients with questions regarding credentialing, re credentialing, participation requirements, contractual issues and high level administrative problems. Performs credentialing and re credentialing activities according to plan specifi

Receives and responds to incoming telephone calls. Answer incoming calls/chats and outgoing calls in a professional, accurate, timely and courteous manner. Communicates professionally at all times. Ascertain the nature of the call and record information in the ASH proprietary systems. Look up caller information using proprietary ASH systems and provide information to the

Analyze, design, develop, and maintain software applications using latest Microsoft technologies, with minimal supervision. Formulates and defines system scope and objectives of complex software applications. Develops an understanding of assigned application and internal customer area, standards and techniques, and general business knowledge. Unit testing as applicable. P

Fitness Center retention and rate revision outreach. Provide follow up to assigned rate revisions and collect fitness center data and report accurate information. Provide follow up to assigned fitness center resignations. Maintains confidentiality of all fitness related records and files. Processes outreach requests to fitness centers and key decision makers within specif

Interfaces with various practitioner types to promote American Specialty Health and to execute practitioner contracts. Makes outbound telephone calls to prospective practitioner types. Meets the minimum required outbound calls per day and per week, as specified by management. Utilizes contact management database. Adheres to standards and practices as outlined in the Pract

Identifies and develops relationships as appropriate with assigned clients to drive new enrollments and achieve sales goals. Makes outbound telephone calls and sources key client contacts in support of STP Team. Initiates outreach to low touch clients to keep them informed of product enhancements and marketing opportunities. Manages client webinar and video logistics and

Manage the medical necessity review of rehabilitation services. Performs medical necessity review of requested services from network and non network Physical Therapy 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.

Receives and responds to telephone calls from members, fitness clubs and health plans. Demonstrates knowledge and understanding of all ASH Fitness products and programs. Answers incoming calls on the ASH telephone system in a professional, accurate, timely, and courteous manner. Ascertains the nature of the call and records information in the appropriate system. Provides

Providing cyber incident response subject matter expertise while collaborating on numerous security projects and operational improvement initiatives. Manage SIEM operations. Support cyber incident response actions to ensure proper assessment, containment, mitigation, and documentation. Hunting to identify anomalous and malicious behavior, enhance SIEM rules to automate co

Provides data entry/clerical support for the Finance Department. Heavy data entry of check information in Excel required. Opens, separates and sorts large volumes of checks and performs analysis to determine the proper entity and bank account for deposit. Logs checks received in Excel spreadsheets and then performs manual confirmation of amounts entered. Uses IHIS program