Current jobs related to Cost Containment Specialist - Aurora - UNITE HERE HEALTH

  • Container Delivery Specialist

    4 days ago

    Aurora, Colorado, United States Waste Connections Full time

    Job SummaryAs a Container Delivery Driver at Waste Connections, you will be responsible for delivering containers using a crane truck or rabbi truck. You will also drive a garbage truck on specified routes to collect solid waste and transport it to appropriate disposal sites.Key ResponsibilitiesDeliver containers to designated locationsOperate a crane truck...

  • Speech and Language Pathologist

    2 months ago

    Aurora, United States Indian Prairie School District 204 Full time

    Position Type: Special Education/Student Services/Speech and Language Pathologist Date Posted: 2/22/2024 Location: Location To Be Determined Date Available: 2024-2025 School Year Closing Date: Until Filled Description: Perform functions to assist students in need of speech and language services. Job Summary: Screen and evaluate students to determine needs...

  • AWS Cost and Commercial Expert

    3 weeks ago

    Aurora, Colorado, United States Amazon Web Services, Inc. Full time

    About the RoleWe are seeking a highly skilled Cloud Optimization Specialist II, Customer Transformation to join our team at Amazon Web Services, Inc. This is a unique opportunity to work with our customers to drive successful IT transformation and cloud adoption.Key ResponsibilitiesAct as a financial advisor and collaborate with our account team to build and...

  • Meat Packaging Specialist

    1 month ago

    Aurora, Illinois, United States inSync Staffing Full time

    Meat Packaging Specialist Compensation: $18.00 per hour Work Schedule: 7:00 AM to 3:30 PM with flexibility required. Monday through Friday and occasional Saturdays Location: Aurora, IL Employment Type: Temporary to Permanent Key Responsibilities: Efficiently pack and repackage meat products in accordance with established guidelines. Accurately measure,...

  • Safety Specialist

    4 months ago

    Aurora, United States Kimbel Mechanical Systems Full time

    Job DescriptionJob DescriptionSafety Specialist Purpose: As a Safety Specialist you will monitor and inspect construction sites to ensure compliance to laws and regulations related to applicable licensing ratios, codes, and specifications.Responsibilities:Inspect and monitor construction sites to ensure adherence to safety standards, licensing ratios,...

  • Janitorial Specialist

    1 week ago

    Aurora, Colorado, United States Merchants Building Maintenance, LLC Full time

    Janitorial Position at Merchants Building MaintenanceWe are seeking a reliable and detail-oriented Janitorial Specialist to join our team at Merchants Building Maintenance, LLC. As a Janitorial Specialist, you will be responsible for maintaining a clean and safe environment for our clients and employees.Key Responsibilities:Empty and clean all waste...

  • Elementary Academic Support Specialist

    4 weeks ago

    Aurora, Colorado, United States INDIAN PRAIRIE SCHOOL DISTRICT 204 Full time

    Position Overview: Understand intervention strategies (objectives, execution with evidence-based fidelity, data collection, etc.) and oversee their application within the school. Guide the execution of student intervention strategies. Assist in creating and executing a district-wide framework that provides educators and administrators immediate access to...

  • Warehouse Operations Specialist

    2 weeks ago

    Aurora, Colorado, United States Penske Transportation Solutions Full time

    Job SummaryWe are seeking a highly skilled and detail-oriented Warehouse Operations Specialist to join our team at Penske Transportation Solutions. As a key member of our warehouse team, you will be responsible for ensuring the efficient and safe movement of goods within our facility.Key ResponsibilitiesTrain new hires on systems, processes, and equipment to...

  • Janitorial Specialist

    2 days ago

    Aurora, Colorado, United States Merchants Building Maintenance, LLC Full time

    Janitorial Position at Merchants Building Maintenance, LLCWe are seeking a reliable and detail-oriented Janitorial Specialist to join our team at Merchants Building Maintenance, LLC. As a Janitorial Specialist, you will be responsible for maintaining a clean and safe environment for our clients and employees.Key Responsibilities:Empty and clean all waste...

  • Elementary Interventionist

    2 weeks ago

    Aurora, Colorado, United States INDIAN PRAIRIE SCHOOL DISTRICT 204 Full time

    Job SummaryWe are seeking a highly skilled Elementary Interventionist to join our team at Indian Prairie School District 204. The successful candidate will be responsible for implementing data-driven instruction and providing targeted support to students in need.Key Responsibilities:Develop and implement a district-wide system for monitoring student progress...

  • Kitchen Sanitation Specialist

    1 month ago

    Aurora, Illinois, United States Compass Group USA Full time

    Position Title: Kitchen Sanitation SpecialistJob Overview:We are seeking dedicated individuals for the role of Kitchen Sanitation Specialist. This position is available in both full-time and part-time capacities, offering flexibility in scheduling to accommodate various availability preferences.Responsibilities:The Kitchen Sanitation Specialist is...

  • Cardiovascular Specialist

    1 week ago

    Aurora, Colorado, United States The Medical Center of Aurora Full time

    Cardiovascular Specialist Job DescriptionThe Medical Center of Aurora is seeking a skilled Cardiovascular Specialist to join our team. As a Cardiovascular Specialist, you will be responsible for providing high-quality patient care and maintaining radiological equipment.Key Responsibilities:Perform routine care and maintenance of radiological...

  • Cardiovascular Specialist

    6 days ago

    Aurora, Colorado, United States The Medical Center of Aurora Full time

    Cardiovascular Specialist Job DescriptionThe Medical Center of Aurora is seeking a skilled Cardiovascular Specialist to join our team. As a Cardiovascular Specialist, you will be responsible for providing high-quality patient care and assisting in invasive and non-invasive cardiac procedures.Key Responsibilities:Perform routine care and maintenance of...

  • Certified Sterile Processing Specialist

    3 weeks ago

    Aurora, Illinois, United States Ascension Full time

    Job SummaryWe are seeking a highly skilled and detail-oriented Certified Sterile Processing Specialist to join our team at Ascension. As a key member of our Sterile Processing department, you will be responsible for ensuring the highest level of quality and safety in the processing and sterilization of medical instruments.Key ResponsibilitiesInstrument...

  • Janitorial Specialist

    2 weeks ago

    Aurora, Colorado, United States Merchants Building Maintenance, LLC Full time

    Janitorial Position SummaryMerchants Building Maintenance, LLC is seeking a reliable and detail-oriented Janitorial Specialist to join our team. As a key member of our facilities maintenance team, you will be responsible for ensuring the cleanliness and organization of our facilities.Key Responsibilities:Empty and clean all waste containersStock restrooms...

  • Sterile Processing Specialist

    2 weeks ago

    Aurora, Colorado, United States Ascension Full time

    About the RoleWe are seeking a highly skilled Sterile Processing Specialist to join our team at Ascension. As a key member of our sterile processing department, you will play a critical role in ensuring the highest level of patient care and safety.ResponsibilitiesInspect and assemble surgical instruments and instrument sets to ensure quality and...

  • Procurement Specialist

    4 weeks ago

    Aurora, Colorado, United States Entegris Full time

    Procurement SpecialistEntegris is seeking a highly skilled Procurement Specialist to join their Procurement Center of Excellence team. As a global resource for Entegris, you will be responsible for creating long-term forecasts to share with suppliers and collaborating with various internal teams to enhance forecast accuracy and tools.Key...

  • Relocation Expense Specialist

    4 days ago

    Aurora, Colorado, United States Graebel Companies Full time

    Job Title: Relocation Expense SpecialistWe are seeking a highly skilled and detail-oriented Relocation Expense Specialist to join our team at Graebel Companies, Inc. in Aurora, Colorado.Job Summary:The Relocation Expense Specialist will be responsible for auditing, processing, and approving disbursements, including tenancy management, education, and...

  • Procurement Specialist

    4 weeks ago

    Aurora, United States LHH Recruitment Solutions Full time

    Job DescriptionProcurement SpecialistThe Procurement Specialist plays a crucial role in acquiring and managing the supply of products and services essential for the organization's operations. This position requires strategic foresight, effective supplier relationship management, negotiation of costs, and ensuring timely delivery of goods. The ideal candidate...

  • Cardiovascular Specialist

    5 days ago

    Aurora, Colorado, United States The Medical Center of Aurora Full time

    Cardiovascular Specialist Job DescriptionThe Medical Center of Aurora is seeking a skilled Cardiovascular Specialist to join our team. As a Cardiovascular Specialist, you will be responsible for providing high-quality patient care and assisting in invasive and non-invasive cardiac procedures.Key Responsibilities:Perform routine care and maintenance of...

Cost Containment Specialist

4 months ago

Aurora, United States UNITE HERE HEALTH Full time
Job DescriptionJob Description

Looking for a way to influence the health and healthcare of many?

If so, we’d love to hear from you Our mission-driven organization is focused on the “Triple Aim” - Better Health, Better Healthcare and Lower Costs to individuals and their families who participate in our health plans.

UNITE HERE HEALTH serves 190,000+ workers and their families in the hospitality and gaming industry nationwide. Our desire to be innovative and progressive drives us to develop impactful programs and benefits designed to engage our participants in managing their own health and healthcare. Our vision is exciting and challenging. Please read on to learn more about this great opportunity

Key Attributes:

  • Integrity – Must be trustworthy and principled when faced with complex situations.
  • Ability to build positive work relationships – Mutual trust and respect will be essential to the collaborative relationships required.
  • Communication – Ability to generate concise, compelling, objective and data-driven reports.
  • Teamwork – Working well with others is required in the Fund’s collaborative environment.
  • Diversity – Must be capable of working in a culturally diverse environment.
  • Continuous Learning – Must be open to learning and skill development. As the Fund’s needs evolve, must be proactive about developing new areas of expertise.
  • Lives our values – Must be a role model for the Fund’s BETTER Culture and Mission (Better, Engage, Teamwork, Trust, Empower, Respect)

The purpose of this position is to support Claims and the automation of the high dollar claim review process. This role would be a liaison between the Claims Department and our networks and vendors, ensuring all information is received and reviewed within outlined timeframes for high-dollar claims that meet the defined criteria.

ESSENTIAL JOB FUNCTIONS AND DUTIES

  • Coordinates with the Claims Support team once medical records are received from the networks
  • Requests medical records from networks if they are not received timely
  • Submits medical records and all pertinent information to Medical Management and/or Claim review vendors
  • Tracks the status of all submitted cases to vendors to ensure timelines are met
  • Follows up with vendors if claims are approaching the deadline
  • Coordinates meetings with vendors and Medical Management as needed
  • Adjudicates corrected claims according to the plan benefit designs
  • Evaluates diagnoses, procedures, services, and other submitted data to determine the need for further investigation related to benefit requirements, the accuracy of the claim filed, and the appropriateness or frequency of care rendered
  • Establishes and maintains relationships with key stakeholders to ensure the successful completion of high dollar claims under review.
  • Offers suggestions on process improvement initiatives by identifying patterns and/or trends
  • Generates and provides regular status reports of high-dollar claims, including trends, challenges, and outcomes to the Leadership team
  • Assists with claims-related projects and reporting as needed
  • Contributes ideas to plans and achieve department goals
  • Demonstrates the Fund’s Diversity and Inclusion (D&I) principles in their conduct at work and contributes to a safe inclusive culture with equitable opportunities for success and career growth
  • Exemplifies the Fund’s BETTER Values in contributing to a respectful, trusting, and engaged culture of diversity and inclusion
  • Performs other duties as assigned within the scope of responsibilities and requirements of the job
  • Performs Essential Job Functions and Duties with or without reasonable accommodation

ESSENTIAL QUALIFICATIONS

Years of Experience and Knowledge

  • 4 ~ 6 years of related experience in a medical claim adjudication environment, or 3 years in a health care or insurance environment
  • Working knowledge and experience interpreting benefit plans, including an understanding of limitations, exclusions, and schedule of benefits
  • Experience with eligibility verification, medical coding, coordination of benefits, and subrogation
  • Experience with medical terminology, International Classification of Diseases (ICD)10 and Current Procedures Terminology (CPT) codes

Education, Licenses, and Certifications

  • Bachelor's degree in Health Care Administration or related field or equivalent work experience required
  • Preferred: AAPC or AHIMA Certification

Skills and Abilities

  • Intermediate level Microsoft Office skills (PowerPoint, Word, Outlook)
  • Intermediate level Microsoft Excel skills
  • Exceptional communication skills (verbal and nonverbal)
  • Excellent presentation skills
  • Ability to work independently
  • Proficient problem-solving skills
  • 10% ~ 15% travel

Hourly range for this position: $24.61~$30.15. Actual hourly rate may vary based upon, but not limited to: relevant experience, qualifications, expertise, certifications, licenses, education or equivalent work experience, time in role, peer and market data, prior performance, business sector, and geographic location.

Work Schedule (may vary to meet business needs): Monday~Friday, 7.5 hours per day (37.5 hours per week) with potential for hybrid work-from-home arrangement.

We reward great work with great benefits, including but not limited to: Medical, Dental, Vision, Paid Time-Off (PTO), Paid Holidays, 401(k), Pension, Short- & Long-term Disability, Life, AD&D, Flexible Spending Accounts (healthcare & dependent care), Commuter Transit, Tuition Assistance, and Employee Assistance Program (EAP).