- The Cigna Group (Bloomfield, CT)
- …basis. + Adheres to professional practice within scope of licensure and certification quality assurance standards and all case management policy and procedures + ... This position, the Nurse Case Manager Senior Analyst , through the case management process, will promote...based on business perspectives. The Case Manager will promote quality cost-effective outcomes managing care needs through the continuum… more
- Medical Mutual of Ohio (OH)
- …assist with determining appropriate rates for provider contracts. . Updates and provides quality assurance of provider rate loading. . Prepares monthly contract ... focus on improvement of financial and/or clinical outcomes. . Updates and provides quality assurance of provider rate loading. . Analyzes payer value-based… more
- Medical Mutual of Ohio (Brooklyn, OH)
- …maintains technical specifications, unit test plans, and dataflow diagrams. Follows quality assurance guidelines including the documentation, review and approval ... **_The_** **_Government Data Analyst III_** **_position allows you the flexibility to...mind to more than 1.6 million Ohioans through our high- quality health, life, disability, dental, vision and indemnity plans.… more
- LA Care Health Plan (Los Angeles, CA)
- …care measures such as those used by National Committee for Quality Assurance (NCQA), HEDIS, Centers for Medicare and Medicaid Services (CMS), and State. ... are used for internal and external reporting, the tasks including data quality assurance , process programming, specification documentation and report developing.… more
- Humana (Columbus, OH)
- …tasks and timelines to ensure compliance with regulatory initiatives. + Conducts quality assurance audits of pre-service organization determinations to ensure ... and help us put health first** The Compliance (UM) Analyst / Professional 2 conducts and summarizes compliance audits. The...need it. These efforts are leading to a better quality of life for people with Medicare ,… more
- TEKsystems (Montgomery, AL)
- …* Validate new or enhanced technical development and implementation and work closely with Quality Assurance Engineers to achieve quality and accuracy * ... have or the challenges you'll encounter. As a Data Analyst within the Enterprise Data Services (EDS) team, you...software development life cycle (ie Business Requirements, Technical Documentation, Quality Assurance ) * Ability to perform data… more
- Medical Mutual of Ohio (Toledo, OH)
- …Creates technical specifications, unit test plans, and dataflow diagrams. Follows quality assurance guidelines including the documentation, review, and approval ... **_The Operations Data Analyst II position allows you the_** **_flexibility to...mind to more than 1.6 million Ohioans through our high- quality health, life, disability, dental, vision and indemnity plans.… more
- WellSense (Boston, MA)
- …collaboratively with other internal IT resources such as Application Development and Quality Assurance + Responsible for IT Demand Management requests including ... Jiva Applications Analyst III WellSense Health Plan is a nonprofit...company serving members across Massachusetts and New Hampshire through Medicare , Individual and Family, and Medicaid plans. Founded 25… more
- Prime Therapeutics (Glen Allen, VA)
- …requestors to resolve questions regarding requested software changes, and participate with Quality Assurance and UAT resources to review related test cases ... our passion and drives every decision we make. **Job Posting Title** Lead Business Analyst **Job Description** The Business Systems Analyst (BSA) Lead IT is… more
- American Institutes for Research (Chapel Hill, NC)
- …analytic data files according to technical specifications, documenting procedures, conducting quality assurance processes, and performing analyses under the ... **Overview** Join AIR as a **Data Analyst ** with ourHealth (https://www.air.org/our-work/health) team. Our Health team...collaboratively to unravel the intertwined challenges of health care quality , costs, and access. Our team of experts -… more
- Aveanna (Morrisville, PA)
- …reports by specified due dates (typically 60 days). + Participate in AES's quality assurance /peer-review process. Submit FBAs and BSPs to an identified colleague ... Board Certified Behavior Analyst ApplyRefer a FriendBack Job Details Requisition #:...with or without notice. + As an employer accepting Medicare and Medicaid funds, employees must comply with all… more
- Hackensack Meridian Health (Edison, NJ)
- …data abstraction efforts align in the data warehouse. + Support DTS by providing quality assurance for analytics tools utilizing quality measures. + Ensures ... healthcare and serve as a leader of positive change. The **Clinical Data Analyst ** is responsible for providing support of the collection, organization and integrity… more
- Convey Health Solutions (Fort Lauderdale, FL)
- …configuration issues in a timely manner through root cause analysis * Complete internal quality assurance and user acceptance testing for work product * Identify ... The Product Configuration Analyst is responsible for the implementation of system...or complementary position leading projects * Experience in the Medicare Managed Care environment preferred, but not required Convey… more
- CareFirst (Baltimore, MD)
- …implement new overpayment/cost avoidance concepts. + Reviews claims edit concept results for quality assurance and proof of concept validation. + Reviews all ... **Resp & Qualifications** **PURPOSE:** The Payment Integrity Analyst is responsible for conducting research and analysis...on their findings. **This role will be focused on Medicare and Medicaid lines of business.** **ESSENTIAL FUNCTIONS:** +… more
- Sutter Health (Sacramento, CA)
- …(eg Centers for Medicare & Medicaid Services (CMS), National Committee for Quality Assurance (NCQA), etc.). *Candidates with a current CPC or CCS-P ... coding guidelines and thorough understanding of the effect of data quality on prospective payment, utilization, and reimbursement for multiple medical professional… more
- Centene Corporation (Jefferson City, MO)
- … & Medicaid Services (CMS)) and performs associated reporting, analysis and quality assurance tasks for medium/low-risk states. + Completes Qualified Health ... Electronic Rates & Forms Filing (SERFF) filings for medium/low-risk states, ensuring quality control, compliance with State and Federal regulations as well as… more
- Molina Healthcare (WI)
- …protocols. + Experience with User Acceptance Testing (UAT) and familiarity with quality assurance (QA) processes to ensure product reliability and performance. ... subject areas. + Must have worked in US Healthcare government programs such as Medicare , Medicaid, the Affordable Care Act, or similar, with experience in one or… more
- LA Care Health Plan (Los Angeles, CA)
- …Solution Center Business Analyst to track, trend, and analyze results of Quality Assurance (QA) scorecards for training and quality improvement. Perform ... Medicare and Medicaid Services(CMS), LACC - CalHers, and National Committee for Quality Assurance (NCQA) along with review and analysis of regulatory… more
- Banner Health (AZ)
- …within the coding department, including roles such as Coding Educator, Coding Quality Analyst and supervisory/management opportunities. Additionally, as part of ... patient treatment information or documentation to coding support tech, coding quality analyst or coding manager for clarification/additional information for… more
- City and County of San Francisco (San Francisco, CA)
- …experience + Engaging staff and improving their experience + Participating in quality assurance activities Once submitted, applicant responses on the Required ... meet all of the following criteria: + Be eligible to participate in Medicare , Medicaid, and/or other federal healthcare programs + Possess a National Provider… more
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