- The Cigna Group (Bloomfield, CT)
- …with AS400, MC400, McNet and RC3 systems required + 3+ years of experience with claims adjudication, claims data types and editing rules (ICD, CPT/HCPC, ... of business within The Cigna Group is hiring a Claims Systems Configuration Quality Review Senior Analyst ....Partner with technology and analytics teams to develop new data sources for reporting and act + as liaison… more
- The Cigna Group (Bloomfield, CT)
- …experience with MC400, McNet and RC3 systems Preferred + 3+ years of experience with claims adjudication, claims data types and editing rules (ICD, CPT/HCPC, ... a division of the Cigna Group is hiring a Claims System Configuration Senior Analyst . This highly...Partner with technology and analytics teams to develop new data sources for reporting and act as liaison between… more
- The Cigna Group (Bloomfield, CT)
- …facing communication and presentation skills, strongly preferred + Knowledge of industry standard claims data types (837, 835, 277, 999) and editing rules (ICD, ... of business within The Cigna Group, is hiring a Claims System Configuration Lead Analyst . This **highly...data file mapping (such as provider, member, auths, claims , etc.) + Design solutions for billing rule, benefits… more
- The Cigna Group (Bloomfield, CT)
- …AS400, MC400, McNet and RC3 systems required preferred + 3+ years of experience with claims adjudication, claims data types and editing rules (ICD, CPT/HCPC, ... a division of The Cigna Group is hiring a ** Claims Systems Configuration Senior Analyst .** For this...Health Services, a division of The Cigna Group, creates pharmacy , care and benefit solutions to improve health and… more
- ProMedica Health System (Toledo, OH)
- …procedures are in place 13. Work as a liaison between departments to provide data requests. 14. Assist as a pharmacy department inventory control specialist in ... within contract pharmacies and hospital outpatient programs. Works closely with system pharmacy team, 340B lead, supply chain, compliance, legal, epic ( pharmacy )… more
- Intermountain Health (Murray, UT)
- …Degree will be verified. - or - Four years of experience in medical/ pharmacy claims processing or benefit coordination within a managed care environment. ... analyze, and manage data , especially in relation to contracts. (Spreadsheet, data analysis tools) + Knowledge of Pharmacy Industry, understanding of the… more
- Beth Israel Lahey Health (Westwood, MA)
- …Responsibilities:** 1. Append appropriate 340B billing modifiers to all applicable claims for resubmission to payer. 2. Navigate 340B claim resubmission rejections ... with payer and escalate rejected claims when applicable. 3. Submit orders for drug replenishments...and/or equivalent work experience considered. + License Mass Registered Pharmacy Tech required. + 1-3 years related work experience… more
- Blue Cross Blue Shield of Massachusetts (Hingham, MA)
- …Bring your true colors to blue. Under the leadership of the Clinical Pharmacy Account Relationship Manager, the Pharmacy Business Expert is supporting the ... This person is responsible for providing administrative support for various pharmacy teams including preparing case management reviews, supporting communications and… more
- CareOregon (Portland, OR)
- …or Public Health + Experience with at least one healthcare data domain (eg, medical claims , pharmacy claims , dental claims , clinical data , etc.) ... Idaho, Arizona, Nevada, Texas, Montana, or Wisconsin. Job Title Data Science Analyst II Exemption Status Exempt... products to facilitate production of insights from healthcare claims , enrollment, and other related data . The… more
- AssistRx (Orlando, FL)
- … data that will be presented to internal teams, clients and partners. The Data Analyst leads the onboarding of electronic data trading partners and ... The Data Quality Analyst is responsible for...quality issues. Successful applicants will have experience with Excel Pharmacy Claims experience is a huge plus… more
- HUB International (Cincinnati, OH)
- …have the perfect employment opportunity for you._ _HUB International is seeking to add a Data Analyst to our growing TOIC platform in our Cincinnati office! This ... be responsible for conducting in-depth analysis on medical and pharmacy claims and utilization to identify trends...indicators that result in actionable plans for clients. The Data Analyst position is a hybrid working… more
- Prime Therapeutics (Eagan, MN)
- …and assists with high-complexity pricing analyses. **Responsibilities** + Analyze and produce pharmacy claims data reporting of varying complexity to ... including data extraction, storage, manipulation, processing and analysis + Analyze claims data of varying complexity to identify and mitigate financial… more
- Centene Corporation (Austin, TX)
- …all or some of the following areas: claims , provider data , member data , clinical data , HEDIS, pharmacy , external reporting + Extract, load, model, ... perspective on workplace flexibility. **Position Purpose:** With the Superior Healthplan Data Analytics and reporting team, you will be responsible for analytic… more
- Medical Mutual of Ohio (OH)
- …sources. . Track record of success with analyzing clinical, claims , pharmacy , program and other administrative data . . Intermediate to advanced knowledge ... . Significant track record of success with analyzing clinical, claims , pharmacy , program and other administrative data . . Advanced knowledge of health… more
- Elevance Health (Columbus, OH)
- …new technologies and a strong, clinical-first lens, to deliver member-centered, lasting pharmacy care. The **PBM Clinical/Benefit Testing Analyst III (Business ... **PBM Clinical/Benefit Testing Analyst III (Business Analyst III)** _Location:...of experience in the US Healthcare domain (Commercial/Medicaid/Medicare) supporting pharmacy including claims processing and benefit administration… more
- Chesapeake Regional Healthcare (Chesapeake, VA)
- …RAC requests, coding reviews, and denials + Ensure accuracy and integrity of charge data prior to billing interface and claims submission + Utilize a ... services, home health care services, durable medical equipment, rehabilitative therapies, and pharmacy reviews from finance and/or claims department + Prepare… more
- Centene Corporation (Frankfort, KY)
- …all or some of the following areas: claims , provider data , member data , clinical data , HEDIS, pharmacy , external reporting + Extract, load, model, ... workplace flexibility. Remote Available **Position Purpose:** Responsible for analytic data needs of the business unit. Handle complex ...data needs of the business unit. Handle complex data projects and acts as a lead for other… more
- The Cigna Group (Franklin, TN)
- …preferred. Requirements + 5 - 7+ years' experience with systems analysis, data analysis and requirements gathering in Healthcare Industry + Thorough understanding of ... how to interpret customer data and business needs and translate them into technical...standard working experience within healthcare that includes ANSI 837 Claims (Institutional, Dental, Professional), 835 (Claim Payment/Remittance), 834 (Benefit… more
- Pharmacy Data Management, Inc. (OH)
- …those products amongst the Customer Success teams. Since 1984, PDMI has provided pharmacy data processing and other flexible, scalable solutions to help our ... PDMI is looking for a Benefits Configuration Analyst to join our team! This role requires...clients meet their business objectives. We offer transparent, pass-through pharmacy processing and other services for private label … more
- Cambridge Health Alliance (Cambridge, MA)
- PACE Health Plan Analyst Apply Refer a Friend Back **Date Posted:** 11/06/2024 **Requisition Number:** 8816 **Location:** CHA East Cambridge Care Center **Work ... working with a PACE health plan third party administrator (TPA) and its PACE pharmacy benefit manager (PBM) to monitor and oversee billing, claims , and accounts… more
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