- Molina Healthcare (Yonkers, NY)
- …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 (Yonkers, NY)
- **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 (Yonkers, NY)
- …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 (Yonkers, NY)
- …**Job Summary** A successful candidate will have a balance of business insight, critical thinking, strong communication and analytical skills. Possess the ... organizational and technical challenges. Performs research and analysis of healthcare claims data, pharmacy data, and external data to derive proper courses… more
- Molina Healthcare (Yonkers, NY)
- **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...and manage information from large data sources. + Analyze claims and other data sources (eg authorization) to identify… more
- Molina Healthcare (Yonkers, NY)
- **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 (Yonkers, NY)
- …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 (Yonkers, NY)
- …during EST hours **Job Summary** Performs research and analysis of complex healthcare claims data, pharmacy data, and lab data regarding network utilization and cost ... skill and analytical methods to look behind the numbers, assess business impacts, and make recommendations through use of healthcare analytics, predictive… more
- Molina Healthcare (Yonkers, NY)
- …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...+ Must have experience in system configuration. + Monitor claims , create , generate and analyze reports using Excel… more
- Molina Healthcare (Yonkers, NY)
- …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 (Yonkers, NY)
- **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
- Nuvance Health (Danbury, CT)
- …claim submission for designated groups of accounts by payer.Insures that all claims are compliant with State and Federal billing regulations and contractual ... Confirmation of electronic and hard-copy billing of any delinquent claims . Rebilling & follow-up of all delinquent claims...impose an undue hardship on the operation or our business . If you believe you require such assistance to… more
- Nuvance Health (Danbury, CT)
- …submission for designated groups of accounts by payer. Insures that all claims are compliant with State and Federal billing regulations and contractual obligations. ... Confirmation of electronic and hard-copy billing of any delinquent claims . Rebilling & follow-up of all delinquent claims...impose an undue hardship on the operation or our business . If you believe you require such assistance to… more
- Molina Healthcare (Yonkers, NY)
- …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 (Yonkers, NY)
- **JOB DESCRIPTION** **Job Summary** Performs research and analysis of complex healthcare claims data, pharmacy data, and lab data regarding network utilization and ... skill and analytical methods to look behind the numbers, assess business impacts, and make recommendations through use of healthcare analytics, predictive… more
- Molina Healthcare (Yonkers, NY)
- …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
- New York State Civil Service (White Plains, NY)
- …following areas of function:* Investigates suspicious activity and can work on the Claims , Premium Audit, Provider Fraud, and/or Data Analytics team on a variety of ... and performance. Preferred Qualifications:* Knowledge in use of IBM i2 Analyst Notebook * Intermediate or Advanced Microsoft software (Excel/PowerPoint)* Desire to… more
- Molina Healthcare (Yonkers, NY)
- …meet data analysis and database development needs. + Reviews, evaluates, and improved business logic and data sources. + Resource to staff for mentoring, coaching, ... and analysis questions. + Reviews Medical Economics analyst work products to ensure accuracy and clarity. + Reviews regulatory reporting requirements and Health Plan… more