- Molina Healthcare (Austin, TX)
- …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
- Molina Healthcare (Austin, TX)
- **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 (Austin, TX)
- …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
- Molina Healthcare (Austin, TX)
- **JOB DESCRIPTION** **Job Summary** Performs research and analysis of complex healthcare claims data, pharmacy data, and lab data regarding network utilization ... numbers, assess business impacts, and make recommendations through use of healthcare analytics, predictive modeling, etc. + Analysis and forecasting of trends in… more
- Molina Healthcare (Austin, TX)
- **JOB DESCRIPTION** **Job Summary** Performs research and analysis of complex healthcare claims data, pharmacy data, and lab data regarding network utilization ... numbers, assess business impacts, and make recommendations through use of healthcare analytics, predictive modeling, etc. + Analysis and forecasting of trends in… more
- Molina Healthcare (Austin, TX)
- …self-navigate organizational and technical challenges. Performs research and analysis of healthcare claims data, pharmacy data, and external data to ... **Job Summary** A successful candidate will have a balance of business insight, critical thinking, strong communication and analytical skills. Possess the… more
- Molina Healthcare (Austin, TX)
- … healthcare operations (utilization management, disease management, HEDIS quality measures, claims processing, etc.) + Knowledge of healthcare financial terms ... **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… more
- Evolent (Austin, TX)
- …reimbursement structures associated with Commercial, Medicare, and Medicaid lines of business . Healthcare claims : specifically, differences between ... **Required** + 2+ years of SAS, SQL Programming Experience with large amounts of healthcare claims and authorization data - **Required** + 2+ years of experience… more
- Molina Healthcare (Austin, TX)
- **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
- Molina Healthcare (Austin, TX)
- …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...Health Plans. + Must have experience with Benefits configuration, claims + The team is responsible for implementation and… more
- Molina Healthcare (Austin, TX)
- **Job Description** **Job Summary** The Analyst , Quality Analytics and Performance Improvement role will support Molina's Quality Analytics team. Designs and ... and reporting related to Managed care data like Medical Claims , Pharmacy, Lab and HEDIS rates. + Assist Quality...overall markets and LOB. + Work in an agile business environment to derive meaningful information out of complex… more
- Molina Healthcare (Austin, TX)
- **Job Description** **Job Summary** Supports ongoing Claims and Enrollment operations in the management of smaller scale, less complex vendor activities. Provides ... as directed by the Enrollment team . Partners with the vendor to analyze business and vendor performance problems and issues using data from internal and external… more
- Evolent (Austin, TX)
- …Excel, SAS, SQL, or similar analytical software to analyze clinical authorization and healthcare claims data + Using analytical tools to integrate various data ... reason why diversity and inclusion are core to our business . Join Evolent for the mission. Stay for the...SQL or SAS is preferred + 2-5 years of healthcare -related experience is preferred **Technical Requirements:** We require that… more
- Molina Healthcare (Austin, TX)
- …used for data/text mining, analysis, modeling, and predicting to enable informed business decisions. Gains insight into key business problems and deliverables ... departments and with customers to define requirements and understand business problems. Uses advanced mathematical, statistical, querying, and reporting methods… more
- Molina Healthcare (Austin, TX)
- …opportunities to support clinical savings initiatives. **KNOWLEDGE/SKILLS/ABILITIES** + Analyze claims and authorization data to identify trends or other issues ... exhibits and data visualizations to illustrate key trend drivers + Work with business owners to track performance indicators of medical interventions + Extract and… more
- Molina Healthcare (Austin, TX)
- …analyses on a variety of topics related to the overall support of business operations. + Creates and maintains reports to manage claim inventory, adjustment ... findings and may develop recommendations to solve problems and issues related to business operations. + Follows team coding standards for report design. Works to… more
- Prime Therapeutics (Austin, TX)
- …analysis to include 1 year of experience in Pharmacy Benefit Management (PBM), claims processing, healthcare , and/or related field + Must be eligible to ... our passion and drives every decision we make. **Job Posting Title** Pricing Analyst - Remote **Job Description** The Pricing Analyst maintains, provides… more
- Sumitomo Pharma (Austin, TX)
- …and to clean up historical utilization that is routinely submitted with Medicaid claims . In addition, the analyst will load Medicaid claim information into ... dynamic, highly motivated, and experienced individual for the position of ** Analyst , Medicaid Rebates.** This individual contributor role is responsible for… more
- Prime Therapeutics (Austin, TX)
- …complex queries to include 3 years of experience in Pharmacy Benefit Management (PBM), claims processing, healthcare , and/or related field + Must be eligible to ... every decision we make. **Job Posting Title** Sr. Pricing Analyst - Pharmacy Network - Remote **Job Description** The...revised financial pricing programs based on analysis of pharmacy claims data, average wholesale drug prices (AWP), and other… more
- HealthEdge Software Inc (Austin, TX)
- …root-cause issues are identified and addressed upstream, and all aspects of claims operations are centralized for comprehensive business intelligence. The ... towards success. **What You Bring:** + Bachelor's degree in Healthcare Administration, Business , Finance, Computer Science, or...degree. + Minimum of 3 years of experience in healthcare payment integrity, content & policy, contracts, claims… more