- Molina Healthcare (ID)
- …sources. **Preferred Qualifications:** + Experience with Medicaid + Experience with medical claims , authorization, and membership data + Advanced proficiency ... **JOB DESCRIPTION** **Job Summary** The Senior Analyst , Medical Economics provides support and...reimbursement changes + Provide data driven analytics to Finance, Claims , Medical Management, Network, and other departments… more
- Crawford & Company (Boise, ID)
- …have been settled and the claim is only open for payment of medical benefits (ie maintenance claims not requiring actuarial reserves). + Contacts, by ... Everything We Touch Position Summary Under direct supervision, processes medical only claims within authority, processes other... claims , other than "M" cases, where all medical issues have been settled and the claim… more
- Molina Healthcare (ID)
- …SKILLS & ABILITIES:** + 1-3 years claims analysis experience + 5+ years medical claims processing experience across multiple states, markets, and claim ... **PREFERRED EXPERIENCE:** + 1-3 years claims analysis + 6+ years medical claims processing experience + Project management + Expert in Excel and PowerPoint… more
- Molina Healthcare (Meridian, ID)
- …business areas. **KNOWLEDGE/SKILLS/ABILITIES** + Provides research and analytics associated with medical claims processing requirements (1500 and UB04), provider ... **JOB DESCRIPTION** **Job Summary** Analyzes complex claim inquiries and reimbursement issues.using data from internal and external sources to expeditiously resolve … more
- Molina Healthcare (ID)
- …sources. + Resource to staff for mentoring, coaching, and analysis questions. + Reviews Medical Economics analyst work products to ensure accuracy and clarity. + ... strategic analysis. **KNOWLEDGE/SKILLS/ABILITIES** Manages and provides direct oversight of Medical Economics Team activities and personnel. Provides technical expertise,… more
- R1 RCM (Boise, ID)
- …accounts. Every day, you will conduct root cause analysis and gather and correct claim information to resolve insurance company medical denials. To thrive in ... you will experience working as a Denials & AR Analyst :** + Investigate and analyze physician-based claims ...claims to identify denial reasons; gather and correct claim information to resubmit claims + Contact… more
- Sumitomo Pharma (Boise, ID)
- …that is routinely submitted with Medicaid claims . In addition, the analyst will load Medicaid claim information into the Commercial Validata system ... dynamic, highly motivated, and experienced individual for the position of ** Analyst , Medicaid Rebates.** This individual contributor role is responsible for… more
- R1 RCM (Boise, ID)
- …with employees throughout the US and international locations. Our Service Delivery Analyst /Ops Lead role will be responsible for backend revenue cycle focused on ... ambiguity and uncertainty as your opportunity to solve problems, innovate and deliver. The analyst /ops lead role will report to the Manager of that region in Service… more
- Molina Healthcare (ID)
- **JOB DESCRIPTION** **Job Summary** Performs research and analysis of complex healthcare claims data, pharmacy data, and lab data regarding network utilization and ... Computer Science, Data Science **Preferred Experience** + Preferred experience in Medical Economics , and Strong Knowledge of Performance Indicators: + Proactively… more
- Molina Healthcare (ID)
- **Knowledge/Skills/Abilities** Performs research and analysis of complex healthcare claims data, pharmacy data, and lab data regarding network utilization and cost ... in Finance, Economics, Math, or Computer Science Preferred experience in Medical Economics and Strong Knowledge of Performance Indicators: + Proactively identify… more
- Evolent (Boise, ID)
- …as we solve complex business problems. **Collaboration Opportunities:** The Senior Analyst , Client Analytics role will be serving key internal (Evolent Account ... + 2+ years of SAS, SQL Programming Experience with large amounts of healthcare claims and authorization data - **Required** + 2+ years of experience using Microsoft… more
- Prime Therapeutics (Boise, ID)
- …Management) experience + Experience conducting complex analysis on large sets of pharmacy, claims , medical , and/or financial data + Basic to intermediate SAS ... decision we make. **Job Posting Title** Sr. Applied Stars and Quality Analytics Analyst **Job Description** The Senior Health Data Analyst provides information,… more
- Molina Healthcare (Caldwell, ID)
- …and Medicare/MMP. + Analysis and reporting related to Managed care data like Medical Claims , Pharmacy, Lab and HEDIS rates. + Assist Quality department ... **Job Description** **Job Summary** The Analyst , Quality Analytics and Performance Improvement role will...rate tracking and supplemental data impact reporting. + Develop Medical Record Review project reporting to track progress and… more
- Molina Healthcare (Idaho Falls, ID)
- …results to identify early signs of trends or other issues related to medical care costs. Recommend solutions to identified issues. + Design and perform actuarial ... studies related to medical care costs and trends. + Design and program...analysis for senior management; effectively communicate results. + Prepare claim experience reports, rate models, and state regulatory reports.… more
- Molina Healthcare (Boise, ID)
- …the business to provide recommendations on opportunities for process improvements, medical cost savings or revenue enhancements. + Create Business Requirements ... the intended functional and operational requirements. + Analysis of claim payment to identify potential recoupment. **JOB QUALIFICATIONS** **Required Education**… more
- Molina Healthcare (Boise, ID)
- **JOB DESCRIPTION** **Job Summary** Performs research and analysis of complex healthcare claims data, pharmacy data, and lab data regarding network utilization and ... Economics, Math, or Computer Science **Preferred Experience** Preferred experience in Medical Economics and Strong Knowledge of Performance Indicators: + Proactively… more
- Molina Healthcare (ID)
- …a thorough, professional and expedient manner. May include evaluation for medical necessity and appropriate levels of care. **Knowledge/Skills/Abilities** + Reviews, ... utilization history using various Molina systems and databases (eg, membership, claims , prior authorization, case management, and complaint tracking systems). +… more
- CVS Health (Boise, ID)
- …address continuous quality improvement initiatives - Analyze and resolve complex claims scenarios within established time frames - Identify and recommend internal ... our colleagues and our communities. The Company offers a full range of medical , dental, and vision benefits. Eligible employees may enroll in the Company's 401(k)… more
- Baylor Scott & White Health (Boise, ID)
- …analytics to support our organization. We seek a stakeholder-facing statistical analyst that will be responsible for the extraction, analysis and interpretation ... candidate's specific qualifications and prior experience. **PRIMARY RESPONSIBILITIES:** The medical economics analytics developer is primarily responsible for extracting,… more
- Prime Therapeutics (Boise, ID)
- …with data consolidation and modeling + Prior PBM experience or experience working with medical claims , pharmacy claims , healthcare and/or benefits data + ... new product development. **Responsibilities** + Analyze or produce reports of varied claims data to assess Prime's products and/or programs; utilize analytics to… more