- Commonwealth Care Alliance (Boston, MA)
- …under the direction of the Sr. Director, TPA Management and Claims Compliance, Healthcare Medical Claims Coding Sr. Analyst will be responsible for ... **Essential Duties & Responsibilities:** + Develop enhanced, customized prospective claims auditing and clinical coding and reimbursement policies and necessary… more
- Molina Healthcare (Columbus, OH)
- …cause and resolve outstanding issues. Creates reports and analysis based on business needs and required or available data elements. Collaborates with Health Plans ... is a general role in which employees work with multiple types of business data. Will work cross functionally across multiple business areas.… more
- Sharp HealthCare (San Diego, CA)
- …Must have strong leadership skills and experience. Knowledge of clinical and business operations in a healthcare environment. Knowledge of hospital and ... marketplace factors, other requirements for the position, and employer business practices. **What You Will Do** The Sr. Systems... practices. **What You Will Do** The Sr. Systems Analyst role within IT is responsible for systems analysis,… more
- Molina Healthcare (Columbus, OH)
- **Job Description** Job Summary Serves as claims subject matter expert. Assist the business teams with reviewing claims to ensure regulatory requirements are ... appropriately applied. Manages and leads major claims projects of considerable complexity and volume that may be initiated through provider inquiries or complaints,… more
- Molina Healthcare (Columbus, OH)
- …Maintains critical information on claims databases. Synchronizes data among operational and claims systems and application of business rules as they apply to ... to be housed on databases and ensure adherence to business and system requirements of customers as it pertains...in research, review and audits for adjudication rates of claims + Must be able to work in cross… more
- State of Colorado (CO)
- Disabled Buy-In Claims Test Analyst Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/4792294) Apply Disabled Buy-In Claims Test ... . https://dhr.colorado.gov/dhr-resources/student-loan-forgiveness-programs We are looking for a Disabled Buy-In Claims Test Analyst for the Testing Support… more
- Guardian Life (Bethlehem, PA)
- Join the dynamic team at Guardian Life as a ** Business Intelligence Analyst III** and be part of a data-driven environment. This role focuses on improving risk ... changes and IT projects. + Provide design support for the development of business intelligence solutions for Dental and Disability Claims , collaborating closely… more
- Guidehouse (Lewisville, TX)
- …experience in lieu of Diploma / GED. + 1-3+ year's experience in within business , operations, customer service or healthcare fields. **What Would Be Nice to ... **Clearance Required** **:** None **What You Will Do** **:** The **Billing Analyst ** is expected to perform specific billing processes, follow-up, account analysis… more
- Molina Healthcare (Long Beach, CA)
- …advanced Excel or SQL. + Must be able to conduct root cause analysis in Healthcare Porvider claims data.. + Experienced in Healthcare domain specifically ... used for data/text mining, analysis, modeling, and predicting to enable informed business decisions. Gains insight into key business problems and deliverables… more
- The Cigna Group (Bloomfield, CT)
- …EviCore, a line of business within The Cigna Group, is hiring a Claims System Configuration Lead Analyst . This **highly technical systems** role acts as the ... initiatives. You'll be the subject matter expert to the business and IT for eviCore claims product...products including PowerPoint - REQUIRED + 5+ years of healthcare claims life cycle experience, emphasis in… more
- TEKsystems (Oakbrook Terrace, IL)
- Description: Stop Loss Claims Analyst is a professional who specializes in managing and analyzing health insurance claims , particularly those that exceed a ... aspects of the role: Review, analyze, manage and adjudicate claims on all applicable lines of business ...and improving outcomes1. Regulatory Compliance: They ensure that all claims are processed in compliance with healthcare … more
- Centene Corporation (Jefferson City, MO)
- … process analysis, preferably in healthcare (ie documenting business process, gathering requirements) or claims payment/analysis experience. Advanced ... implement process improvements. + This role will focus on claims configuration for the state of Georgia Behavioral Health....in related field or equivalent experience. 6+ years of business process or data analysis preferably in healthcare… more
- Centene Corporation (Olympia, WA)
- …management experience preferred. ** Claims and Payment Analysis:** 6+ years of business process analysis, preferably in healthcare (ie documenting business ... Bachelor's degree in related field or equivalent experience. 6+ years of business process or data analysis preferably in healthcare . Advanced knowledge… more
- Teva Pharmaceuticals (Parsippany, NJ)
- Medicaid Claims Analyst Date: Jan 6, 2025 Location: Parsippany, United States, New Jersey, 07054 Company: Teva Pharmaceuticals Job Id: 59984 **Who we are** Teva ... us on our journey of growth! **The opportunity** **Position Summary:** The Medicaid Claims Analyst is responsible for Medicaid Drug Rebate process which includes… more
- Hackensack Meridian Health (Edison, NJ)
- …healthcare and serve as a leader of positive change. The **Applications Analyst III** gathers business requirements, conducts needs assessments, and develops ... specifications and build to ensure that developed information technology solutions support business objectives. This level works with little or no supervision and… more
- UPMC (Pittsburgh, PA)
- **Purpose:** The function of the Associate Accounts Receivable Claims Analyst is to ensure all HRA, FSA , ASO & Stop Loss related reporting & reconciliation, ... claims utilization billing, and employer group reimbursements are completed...High School diploma or GED + Bachelor's Degree in Business Administration- Accounting, Finance or related field preferred +… more
- Teva Pharmaceuticals (Parsippany, NJ)
- Medicaid Claims Analyst Date: Jan 15, 2025 Location: Parsippany, United States, New Jersey, 07054 Company: Teva Pharmaceuticals Job Id: 60239 **Who we are** Teva ... healthier lives. Join us on our journey of growth! **The opportunity** The Medicaid Claims Analyst is responsible for Medicaid Drug Rebate process which includes… more
- VNS Health (Manhattan, NY)
- OverviewWorks directly with management on highly visible projects to understand business needs and challenges of managed care payors and to develop innovative ... requirements, performs analysis, designs new or enhanced systems to meet operational, business , and clinical needs. Collaborates with Business Unit and/or… more
- Fairview Health Services (Minneapolis, MN)
- **Overview** The Senior Application PB/HB Claims Analyst role with Epic Hospital and/or Professional billing (HB and/or PB) will provide technical expertise and ... application area. Job functions include configuring applications by translating the business requirements into software specifications. This position is eligible for… more
- Catholic Health Services (Melville, NY)
- …are committed to caring for Long Island. Be a part of our team of healthcare heroes and discover why Catholic Health was named Long Island's Top Workplace! Job ... Details Under minimal supervision, formulates and defines Resolute Hospital Billing/ Claims scope and objectives through research and fact-finding to develop or… more
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