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Govt Programs Grievance Coord
HCSC - Tulsa, OK
"If chosen to proceed, each candidate will be required to complete a video interview via HireVue." BASIC FUNCTION: This position is responsible for receiving, processing, and responding to all Government Programs Member Grievances (complaints); prepares responses to the member and to Human Services Division (HSD) as required; prepares the Summary of Evid...
Contract Specialist
HCSC - Tulsa, OK
BASIC FUNCTION: This position is responsible for drafting of standard and customized account-specific documents for new and renewing accounts with redrafts of up to ten paragraphs. This position is responsible for drafting non-standard contract language and coordinating the production of documents working with account managers. This position is respons...
Technical Operations Analyst (Value Based Care)
HCSC - Tulsa, OK
Technical Operations Analyst (Value Based Care) At HCSC, building a talent engine for the future is a key priority because we recognize that as our business evolves to reflect the changing world, we must adapt our workforce to meet this challenge. Additionally, with "excellence" as one of our core values, we are focused on improving our success measures and...
Account Executive - Life, Ancillary
HCSC - Tulsa, OK
Located in Tulsa, OK this position is responsible for a variety of field office sales and sales support activities for ancillary products. This includes implementation and enrollment support, cross-selling lines of coverage, product education, customer service and problem-solving, as well as renewal persistency. The Account Executive is also responsible for building ...
RN - Medical Mgmt Specialist I (Care Coordination)
HCSC - Sapulpa, OK
**This position is located in Creek County** JOB PURPOSE: This position is responsible for conducting medical management and health education programs for customers on government health care programs. Accountabilities include gathering, analyzing and providing date for regulatory reports. This position will represent the company ...
RN - Wellbeing Health Advisor
HCSC - Tulsa, OK
**This position is located in Tulsa, Oklahoma** Job Purpose: This position will be responsible for focusing on the overall health of the member by assisting the member with the goal of increased health and overall wellbeing by developing a one-to-one relationship with the member. Encourage members to utilize appro...
Coding Compliance Specialist
HCSC - Tulsa, OK
BASIC FUNCTION: Under supervision, this position is responsible for researching and analyzing the medical records when there is a discrepancy in coding; validating the coding and supporting the department in the reporting of findings. This position audits medical records to ensure compliance with the organizations coding procedures and standards according to the CMS Coding G...
Senior Internal Auditor II
HCSC - Tulsa, OK
Job Purpose: This purpose of this position is to coordinate and facilitate complex regulatory examinations conducted by federal and state regulators and assist HCSC management in the successful completion of regulatory exams. The position is responsible for interaction with regulators and promptly communicating and triaging requests from regulator...
Coding Compliance Specialist
HCSC - Tulsa, OK
BASIC FUNCTION: Under supervision, this position is responsible for researching and analyzing the medical records when there is a discrepancy in coding; validating the coding and supporting the department in the reporting of findings. This position audits medical records to ensure compliance with the organizations coding procedures and standards according to the CMS Coding G...
Consultant -Internal Consulting Group
HCSC - Tulsa, OK
Job Purpose: This position is responsible for leading and/or supporting a broad array of ad hoc consulting engagements across HCSC to drive strategic, operational, and organizational improvements. Project responsibilities include targeted strategic assessments, solution implementations, and process design and improvement efforts. Responsible for leading ...
Customer Advocate I
HCSC - Tulsa, OK
BASIC FUNCTION: Under supervision and following unit specific coaching and training, this position is responsible for researching and responding to telephone and written inquiries within the statutory time frames and in an accurate and objective manner; collecting non-clinical data; determining benefit levels according to contract guidelines; completing notification of mater...
Member Care Coordinator - Tulsa County
HCSC - Tulsa, OK
**This position is based in Tulsa County** BASIC FUNCTION: This position is responsible for conducting home health assessment, contacting identified members to inform and educate them on health care programs to address their personal health plan needs, engaging the member in discussion of adherence to personal health plans,...
Network Regulatory Analyst
HCSC - Tulsa, OK
BASIC FUNCTION: This position is responsible for all Network Management audit and compliance activities. Coordinates with core provider credentialing, quality assurance, Medicare Office, Medicaid Office, NCQA or URAC, Appeals, and all internal staff members to assure compliance according to corporate policy and conducts all internal and external audits; responsible for the o...
Analytics & Reporting Analyst
HCSC - Tulsa, OK
***This position to be filled in either Tulsa or Oklahoma City only*** ***At this time, BCBS of OK is not sponsoring candidates with Visa requirements*** BASIC FUNCTION: This position is responsible for creating reports, insights and analytics in support of the division; creating specifications for reports and analysis based on business need...
Provider Relations Representative
HCSC - Tulsa, OK
***There are multiple openings associated with this posting*** BASIC FUNCTION: This position is responsible for enhancing relationships with facility and physician providers; and acting as liaison with providers through education, training, claims assistance and ongoing provider service. JOB REQUIREMENTS: *Bachelor Degree and 1 year managed care exp...
