- Molina Healthcare (WI)
- …claims databases. Synchronizes data among operational and claims systems and application of business rules as they apply to each database. Validate data to be housed ... on databases and ensure adherence to business and system requirements of customers as it pertains...existing health plans. + Must have experience working on QNXT/ Medicare /NetworX + Must have experience working on SQL. +… more
- Medical Mutual of Ohio (Brooklyn, OH)
- …finance experience . Certified Public Accounting (CPA) preferred Sr . Financial Analyst . Bachelor's degree in Business , Accounting, Finance, or a ... departments, ensuring financial processes are efficient and aligned with company goals. Sr Financial Analyst Responsible for analyzing financial trends, creating… more
- CommonSpirit Health (Englewood, CO)
- …happen both inside our hospitals and out in the community. **Responsibilities** The ** Senior Reimbursement Analyst i** s responsible for providing cost report ... , Medicaid and other State and Federal regulations. The Sr . Reimbursement Analyst interacts with customers and...Analyst also assists in the improvement of internal business processes and meeting future reimbursement service needs. The… more
- Commonwealth Care Alliance (Boston, MA)
- …. Director, TPA Management and Claims Compliance, Healthcare Medical Claims Coding Sr . Analyst will be responsible for developing prospective claims auditing ... This role will ensure that the applicable edits are compliant with applicable Medicare and Massachusetts Medicaid regulations. The role will also be responsible for… more
- Kepro (Albany, NY)
- …a vital partner for health solutions in the public sector. Acentra is looking for a Senior Business Analyst to join our growing team. Job Summary: Senior ... Business Analyst is responsible for analyzing business problems, identify gaps, and develop technical solutions involving...large complex projects. + You have a Medicaid / Medicare (healthcare) background. + You have Business … more
- Prime Therapeutics (Columbus, OH)
- …our passion and drives every decision we make. **Job Posting Title** Claims Technical Analyst , Sr . **Job Description** The Senior Claims Technical Analyst ... efforts for department level applications. **Responsibilities** + Serve as lead Analyst for complex and/or escalated analysis requests; coordinate requests from… more
- Prime Therapeutics (Columbus, OH)
- …passion and drives every decision we make. **Job Posting Title** Regulatory Analyst Sr - Remote **Job Description** The Senior Regulatory Analyst is ... processes, and participates in committee review meetings within the Commercial, Medicare , Medicaid, and Health Insurance Marketplace for the assigned department.… more
- CVS Health (Columbus, OH)
- …detailed oriented individual to join the Reporting & Vendor Support Team. As a Senior Analyst , you will be responsible for daily reporting, vendor partnership, ... auditing, provisioning, and QuickBase development that supports the Medicare Enrollment Department. Our team is member centric and...oracle and DB2. + Ability to manage effectively with business partners, vendors, and senior leaders. +… more
- Prime Therapeutics (Columbus, OH)
- …fuels our passion and drives every decision we make. **Job Posting Title** Sr . Compliance Analyst (Regulatory Intelligence and Assessment) - Remote **Job ... Description** The Senior Compliance Analyst assists in the implementation...organization to validate regulatory requirements are met and that business operations are aligned with expectations of applicable regulatory… more
- Medical Mutual of Ohio (Brooklyn, OH)
- …insured and self-funded group coverage, including stop loss, as well as Medicare Advantage, Medicare Supplement, and individual plans. Implements and manages ... the implementation and daily operation of the Medicare Advantage Compliance Program and all compliance-related activities for the Company's Medicare Advantage… more
- Providence (WA)
- …retain the best people, we must empower them._** **Providence Health Plan is calling a Senior Actuarial Analyst , Medicare Bid who will:** + Be responsible ... and providing strategic insights to support the pricing and bidding process for our Medicare Advantage plans + Have a deep understanding of Medicare Advantage… more
- Dana-Farber Cancer Institute (Brookline, MA)
- …location for this position is full remote with occasional time onsite.** The Medicare Coverage Analyst (MCA) is responsible for reviewing clinical research ... to patient insurance and which should be billed to the study sponsor. The Medicare Coverage Analyst determines whether proposed clinical research studies are a… more
- Point32Health (Boston, MA)
- …Point32Health, click here (https://youtu.be/S5I\_HgoecJQ) . **Job Summary** This Senior Actuarial Analyst will support the Medicare Part C Pricing work. The ... key responsibilities for this role are pricing, rate filing ( Medicare Advantage Bid) development, strategic analysis, and other ad hoc projects. This role will also… more
- Robert Half Management Resources (Brockton, MA)
- Description We are in search of a Sr . Financial Analyst to join our team in Brockton, Massachusetts. In this role, you will be tasked with various external and ... regulatory reporting duties, month-end accounting tasks, contract analysis, new business development, and net revenue forecasting, among other responsibilities. This… more
- Molina Healthcare (FL)
- **JOB DESCRIPTION** **Job Summary** The Senior Analyst , Medical Economics provides support and consultation to the Health Plan and Finance team through analyzing ... key business issues related to cost, utilization and revenue for...tools to monitor trend drivers and provide recommendations to senior leaders for affordability opportunities. Responsible for conducting complex… more
- CareFirst (Washington, DC)
- **Resp & Qualifications** **PURPOSE:** The Senior Public Policy Analyst monitors, evaluates, and provides recommendations on strategy and communications ... regarding federal and state public policy issues in support of the company's business objectives and requirements. The Analyst has key responsibility for… more
- The Cigna Group (Bloomfield, CT)
- …and providers **Summary description of position:** This position, the Nurse Case Manager Senior Analyst , through the case management process, will promote the ... Scope:** + Manages/coordinates an active caseload of case management cases for Cigna Medicare . Uses clinical knowledge to assess the treatment plan and goals, and… more
- Molina Healthcare (WA)
- **JOB DESCRIPTION** **Job Summary** Analyzes complex business problems and issues using data from internal and external sources to provide insight to ... influences. Constructs forecasts, recommendations and strategic/tactical plans based on business data and market knowledge. Creates specifications for reports and… more
- The Cigna Group (Nashville, TN)
- …of information and analytics to improve health and optimize consumer focused business processes. + Possess technical knowledge of all phases of applications systems ... specifications across multiple platforms for information systems solutions which address business needs and methods. + Conducts testing and system validation to… more
- Healthfirst (NY)
- …is achieving desired results. + Keep abreast of New York Medicaid and Medicare reforms and their impact on Healthfirst and their owner hospital performance. ... Member Per Month (PMPM) and revenue. + Basic understanding of Medicaid and Medicare programs or other healthcare plans. + Self-motivated, creative problem solver who… more