- CenterWell (Baton Rouge, LA)
- …our caring community and help us put health first** The Manager of Pre -Bill Audit provides strategic leadership and operational oversight for the organization's ... pre -billing function. This role is responsible for ensuring all claims are audit-ready prior to release, driving standardization across branches, and delivering… more
- Humana (Baton Rouge, LA)
- …claims in accordance with TRICARE policy requirements. This role involves reviewing pre -payment, high dollar claims to assess payment accuracy and identify ... **Become a part of our caring community and help us put health first** The Claims Risk Management Professional is responsible for ensuring payment quality of … more
- Humana (Baton Rouge, LA)
- …+ Previous encounter submissions experience + Prior internship or experience in healthcare data management, claims processing, or actuarial services + Working ... knowledge of Microsoft SQL or SAS + Understanding of healthcare encounter data and basic knowledge of claims submission and reconciliation processes. + Strong… more
- Humana (Baton Rouge, LA)
- …Excel (pivot tables, VLOOKUP, formulas) + Familiarity with Medicaid systems, claims platforms, and reconciliation tools **Work-At- Home Requirements** + At ... existing Medicaid business processes, with a focus on eligibility, enrollment, claims , and compliance workflows. This role develops sustainable, repeatable, and… more
- Blue Cross and Blue Shield of Louisiana (Baton Rouge, LA)
- …new and existing, complex reimbursement programs. Designs system specifications that support claims payment and criteria for data bases that support analysis as well ... of a Master's degree in Business, Information System and Decision Sciences, Healthcare Administration or Public Health. + Four years of related experience can… more
- Blue Cross and Blue Shield of Louisiana (Baton Rouge, LA)
- …passion for providing excellent customer service? Would like you like to work from home ?** **We are actively recruiting for a Call Center Class beginning in February ... and access to grow your career **POSITION PURPOSE** Resolves benefit and claims inquiries received via the telephone, in person, or other acceptable receipt… more
- Humana (Baton Rouge, LA)
- …escalations. **Use your skills to make an impact** **WORK STYLE:** Remote/Work at Home . While this is a remote position, occasional travel to Humana's offices for ... certification experience utilizing coding guidelines by reading and interpreting claims + Exceptional understanding of Centers for Medicare &...hours are 8AM - 5PM Eastern time. **Work at Home Requirements** * At minimum, a download speed of… more
- Blue Cross and Blue Shield of Louisiana (Baton Rouge, LA)
- …Responsible for coordinating, processing and managing all in-patient and out-patient claims from a medical standpoint to ensure proper administration of contractual ... effectively fulfill this position, the incumbent must be in contcact with: Healthcare providers and subscribers to obtain medical information. Obtains request for… more
- Oracle (Baton Rouge, LA)
- …MS Excel, MS Word + Highly desirable to have: + Experience using EHR and/or healthcare claims data + Familiarity with Python or other programming language At ... **Evidence Generation Lead/Snr Research Consultant, RWE, Health Outcomes** **Remote/Work from home ** Oracle Life Sciences is seeking a qualified health outcomes… more
- Evolent (Baton Rouge, LA)
- …seamlessly with diverse teams and stakeholders. + Deep understanding of healthcare claims , reimbursement methodologies, and cost/utilization KPIs, including ... preferred. + 10+ years of analytics & reporting experience in healthcare , including medical economics, cost/utilization analysis, and membership trend reporting. +… more
- Blue Cross and Blue Shield of Louisiana (Baton Rouge, LA)
- …monitor, and evaluate options and services required to meet the member's healthcare needs. Through communication, the nurse will identify available resources to ... needs to make decisions. + Ability to plan, implement and evaluate appropriate healthcare services in conjunction with a physician treatment plan and evaluate the… more
- Evolent (Baton Rouge, LA)
- …to ensure clean and consistent tracking of Evolent's covered membership and claims + Synthesize complex analyses into succinct presentations for communication to key ... of Actuaries credentials with Group Health track **(Preferred)** + Familiarity with healthcare claim processing **(Preferred)** + 5+ years experience at payer or… more