- Public Consulting Group (Harrisburg, PA)
- …Education + Recovery Services **Duties and Responsibilities** + Analyzes the development of claims assigned at each level of the adjudication process. + Outlines the ... sent with applications. + Monitors and gives direction to Claims Developer regarding specific tasks on claims ....to Claims Developer regarding specific tasks on claims . + Provides monthly reporting statistics. + Ensures adherence… more
- UPMC (Pittsburgh, PA)
- **Purpose:** The function of the Associate Accounts Receivable Claims Analyst is to ensure all HRA, FSA , ASO & Stop Loss related reporting & reconciliation, ... claims utilization billing, and employer group reimbursements are completed...Accounting, Finance or related field preferred + Minimum of 1 year of healthcare, insurance, or other financial experience… more
- Prime Therapeutics (Harrisburg, PA)
- …our passion and drives every decision we make. **Job Posting Title** Pricing Analyst - Remote **Job Description** The Pricing Analyst maintains, provides ... with high-complexity pricing analyses. **Responsibilities** + Analyze and produce pharmacy claims data reporting of varying complexity to assess competitiveness &… more
- Prime Therapeutics (Harrisburg, PA)
- …passion and drives every decision we make. **Job Posting Title** Sr. Pricing Analyst - Pharmacy Network - Remote **Job Description** The Senior Pricing Analyst ... Recommend new and revised financial pricing programs based on analysis of pharmacy claims data, average wholesale drug prices (AWP), and other relevant data of… more
- CVS Health (Harrisburg, PA)
- …to GPS to rework claims after validating as overpaid **Required Qualifications** * 1 years experience working with GPS and ECHS * Knowledge of ACAS claims ... This position will be responsible for utilizing previous ACAS claims experience along with provided guidance to review and...experience along with provided guidance to review and validate claims for overpayment. The ideal candidate will be able… more
- WellSpan Health (York, PA)
- Pharmacy 340B Program Analyst - Full Time - Day Shift Location: WellSpan Health, York, PA Schedule: Full Time Schedule: Full Time 40-hours per week Monday - Friday ... qualified patients, drugs and locations. Monitors and audits state Medicaid claims to ensure compliance to prevent potential duplicate discount rebates. Evaluates… more
- CGI Technologies and Solutions, Inc. (Plymouth Meeting, PA)
- **Life Insurance Process Analyst ** **Category:** Business Analysis (functional and technical) **Main location:** United States, Connecticut, Hartford **Alternate ... CGI is seeking a highly skilled and experienced Life Insurance Process Analyst with a strong background in Life Insurance operations. The ideal candidate… more
- UPMC (Pittsburgh, PA)
- **Purpose:** The Clinical Trial Coverage Analyst is responsible for ensuring the financial compliance and proper coverage of clinical trial procedures. This role ... analysis in order to assist in the management of claims review, as well as identifying items that are...+ 3 years of experience in clinical trials. + 1 year of experience in Medicare coverage determination preferred.… more
- Penn State Health (Hershey, PA)
- …Health Corporation** **Location:** US:PA: Hershey **Work Type:** Full Time **FTE:** 1 .00 **Shift:** Day **Hours:** 8:00a - 4:30p **Recruiter Contact:** Garrett C. ... (EHR and other clinical applications) and operational data sets (ex: claims , CMS/TJC, eCQMs, NSQIP, GWTG, etc.). Responsible for supporting clinical decision… more
- Guthrie (PA)
- …reporting appeals performance. Develops and maintains process for identifying under‐allowed claims using the contract module and other available tools. Establishes, ... a must. Ability to perform analysis and reports. Essential Functions: 1 . Responsible for monitoring commercial contracts payment and contractual allowances,… more
- CVS Health (Harrisburg, PA)
- …managed care or population health - 2+ years of customer or patient-facing experience - 1 -2 years Enhanced knowledge of pharmacy and claims processing - Excellent ... organizational and analytical skills - Superior communication skills with patients and clinicians - Ability to prioritize daily to monthly deliverables - Computer Skills: Proficient in Microsoft Excel, Microsoft Teams, and Sharepoint **Preferred… more
- Guthrie (Sayre, PA)
- …11. Performs testing and monitoring of new system logic or process with Business Analyst and/or Manager. Other Duties: 1 . Answers phone calls and correspondence ... I and related support staff. Works closely with Director, Manager, Supervisor and Application Analyst on day to day priorities and to maintain a high level of… more
- UPMC (Pittsburgh, PA)
- …to less experienced staff in the performance of duties. May directly manage 1 analyst . + Build strong relationships within cross-functional workgroups including ... and actionable insights and deliver results to leadership. + Incorporate healthcare claims cost and utilization trends into the development of projections used to… more
- Prime Therapeutics (Harrisburg, PA)
- …years of work experience. + Prior experience as a Business Intelligence Developer/ Analyst or Data Analyst supporting business intelligence, reporting, analytics ... that may be in use in a Pharmacy Benefit Management setting ( Claims Processing, Prior Authorization, Telephony, Membership, etc.). + Consideration will be given… more
- CSL Behring (King Of Prussia, PA)
- …product(s) + Accountable for the Target Product Profile (TPP) and Target Product Claims (TPC) that form the future foundation of product labelling and other forms ... external business portfolio reporting (eg, internal product/project briefings, R&D Analyst Day, annual results communications) + Transparent risk, opportunity, and… more
- Baylor Scott & White Health (Harrisburg, PA)
- …while aligning with internal SMEs and current capacities. We have over 1 million lives across multiple blocks of business and industry-leading analytics to ... support our organization. We seek a stakeholder-facing statistical analyst that will be responsible for the extraction, analysis and interpretation of data to… more
- Prime Therapeutics (Harrisburg, PA)
- …Title** Treasury Reporting Principal - Remote **Job Description** The Treasury Analyst Principal is responsible for managing, analyzing, and delivering Treasury ... Team and guidance to the Accounting, Finance, Information Technology and Claims operation functions. **Responsibilities** : + Develop, manage, and advance monthly… more