- Molina Healthcare (KY)
- …Operations teams + Interprets, communicates, and presents, clear in-depth analysis of claims research results, root cause analysis, remediation plans and fixes, ... **Job Description** **Job Summary** Serves as claims subject matter expert. Assist the business teams...Molina. Identifies the root cause of processing errors through research and analysis, coordinates and engages with appropriate departments,… more
- Molina Healthcare (KY)
- …cross functionally across multiple business areas. **KNOWLEDGE/SKILLS/ABILITIES** + Provides research and analytics associated with medical claims processing ... requirements (1500 and UB04), provider and benefit configuration, and other claim reimbursement drivers + Recognizes, identifies and documents changes to existing business processes and identifies new opportunities for process developments and improvements. +… more
- Elevance Health (Louisville, KY)
- …and content strategy to meet financial and operational targets. The Clinical Content Analyst role will research and interpret CMS, CPT/AMA and other major ... **Clinical Content Analyst ** **Location:** This position will work a hybrid...through review, testing and finally data validation. + Develops claims editing logic and content that promotes payment accuracy… more
- Sumitomo Pharma (Frankfort, KY)
- …and to clean up historical utilization that is routinely submitted with Medicaid claims . In addition, the analyst will load Medicaid claim information into ... assets, and in-house advanced technology capabilities, we aim to accelerate discovery, research , and development to bring novel therapies to patients sooner. For… more
- Molina Healthcare (KY)
- **JOB DESCRIPTION** **Job Summary** Performs research and analysis of complex healthcare claims data, pharmacy data, and lab data regarding network utilization ... of assigned reports, document reporting processes and procedures. + Assist with research , development and completion of special projects as requested by various… more
- Prime Therapeutics (Frankfort, KY)
- …decision we make. **Job Posting Title** Sr. Applied Stars and Quality Analytics Analyst **Job Description** The Senior Health Data Analyst provides information, ... **Additional Qualifications** + Advanced troubleshooting skills, including in-depth client data research , which may involve research and drivers of utilization;… more
- Molina Healthcare (Owensboro, KY)
- …Description** Who you are : + You have proven experience as a QA Analyst within an Agile environment. + Experienced testing on-premise and cloud based ETL/BI ... You can prioritize. + You have experience with QNXT, claims processing , healthcare insurance and SQL + You...QA role within our Agile team is a Senior Analyst position dedicated to ensuring the highest quality standards… more
- Molina Healthcare (KY)
- **Knowledge/Skills/Abilities** Performs research and analysis of complex healthcare claims data, pharmacy data, and lab data regarding network utilization and ... support for finance, pricing and actuarial functions + Healthcare Analyst I or Financial/Accounting Analyst I experience...functions + Healthcare Analyst I or Financial/Accounting Analyst I experience desired + Multiple data systems and… more
- Molina Healthcare (Bowling Green, KY)
- **Job Description** **Job Summary** The Analyst , Quality Analytics and Performance Improvement role will support Molina's Quality Analytics team. Designs and ... and Identifying targeted Interventions and tracking outcome. Assist with research , development, and completion of special performance improvement projects.… more
- Molina Healthcare (KY)
- …for accurate and timely maintenance of critical provider information on all claims and provider databases. Maintains critical provider information on all claims ... Generates Provider Related reports to facilitate and support Provider Services/Provider Problem Research & Resolution. + Must be able to write policies and… more
- CVS Health (Frankfort, KY)
- …setup essential for online viewing and processing related to Customer Service, Claims , Enrollment, Billing and Reporting in support of internal and external ... (Quality, Renewals, Client Advocate, and/or Account Owner preferred) + Salesforce + Ability to research and look beyond the first right answer to find the root of a… more
- Molina Healthcare (Owensboro, KY)
- …+ Actively participates in all stages of project development including research , design, programming, testing and implementation to ensures the released product ... operational processes including but not limited to Enrollment, UM, Claims & Care Management** **Preferred License, Certification, Association** Certified Business… more
- Molina Healthcare (Louisville, KY)
- …analysis. + Works with internal, external and enterprise clients as needed to research , develop, and document new standard reports or processes. + Implements and ... to support the departments goals. + SQL, Databricks, Python + Claims knowledge/QNXT **JOB QUALIFICATIONS** **Required Education** Associate's Degree or equivalent… more