- Molina Healthcare (Austin, TX)
- …Operations teams . Interprets, communicates, and presents, clear in-depth analysis of claims research results, root cause analysis, remediation plans and fixes, ... SKILLS & ABILITIES: . 2-5 years of experience in medical claims processing, research , or a related field . Demonstrates familiarity in a variety… more
- CAI (Austin, TX)
- …claims and appeals in compliance with regulatory standards, while performing claims research , authorization lookups, and maintaining case assignments. **Job ... claims and appeals in compliance with regulatory standards, while performing claims research , authorization lookups, and maintaining case assignments. This is… more
- Wolters Kluwer (Austin, TX)
- …highly skilled Business Analyst to join the Mediregs team focusing on claims processing and the RCM process. The ideal candidate will have a strong understanding ... for our customers. **Additional Information:** https://www.wolterskluwer.com/en/solutions/mediregs **Key Responsibilities:** + Research , analyze and interpret CMS rules and claims… more
- Molina Healthcare (Austin, TX)
- …processing issues + Interprets, communicates, and presents, clear in-depth analysis of claims research results, root cause analysis, remediation plans and fixes, ... cross functionally across multiple business areas. **KNOWLEDGE/SKILLS/ABILITIES** + Provides research and analytics associated with medical claims processing… more
- Molina Healthcare (Austin, TX)
- …+ Must have experience in research , review and audits for adjudication rates of claims + Must be able to work in cross functional teams + Must have experience ... accurate and timely implementation and maintenance of critical information on claims databases. Maintains critical information on claims databases. Synchronizes… more
- Sumitomo Pharma (Austin, TX)
- …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
- Evolent (Austin, TX)
- …Stay for the culture. **What You'll Be Doing:** **Job Posting: Senior Analyst , Performance Analytics** **Location: Remote** Evolent is seeking a Senior Analyst ... with a quantitative major (eg actuarial, statistics, biostatistics, operations research , mathematics, economics) or healthcare major (health administration, epidemiology,… more
- Molina Healthcare (Austin, TX)
- …ability to work independently, self-navigate organizational and technical challenges. Performs research and analysis of healthcare claims data, pharmacy data, ... and existing health plans. + Completes analysis on retroactive claims reports + Pre and post validation of complex...Requires assistance with schema from Tech resource or Lead Analyst . + Writes Requirements for BRDs/FRDs and Reports. +… more
- Prime Therapeutics (Austin, TX)
- …our passion and drives every decision we make. **Job Posting Title** Health Data Analyst Sr- REMOTE **Job Description** The Senior Health Data Analyst provides ... **Additional Qualifications** + Advanced troubleshooting skills, including in-depth client data research , which may involve research and drivers of utilization;… more
- Prime Therapeutics (Austin, TX)
- …program manuals are effectively followed and/or maintained. Works independently to research and resolve regulatory inquiries/complaints related to claims , ... and drives every decision we make. **Job Posting Title** Senior Compliance Analyst (Regulatory Complaints & Inquires) - Remote **Job Description** The Regulatory… more
- Molina Healthcare (Austin, TX)
- **Job Description** **Job Summary** The Sr Analyst , Risk Adjustment - Predicitve Analytics role supports Molina's Risk Adjustment Predictive Analytics team. Designs ... to suport Molina's Prospective and Retrospective Interventions. Assist with research , development,and completion of special projects. **Knowledge/Skills/Abilities** + Assist… more
- Molina Healthcare (Austin, TX)
- **Job Description** **Job Summary** The Sr. 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
- Highmark Health (Austin, TX)
- …subject matter expert in strategy development for new strategic programs. + Research claims processing problems, perform initial problem identification and ... effectively to explain technical benefits, application of medical policy, and claims processing capabilities and functionality. + Work independently or a team… more
- Molina Healthcare (Austin, TX)
- …other end users for operational and strategic analysis. **KNOWLEDGE/SKILLS/ABILITIES** + Performs research and analyses on a variety of topics related to the overall ... audits, compliance, recoveries, coordination with other departments. + Consolidates research and analyses into summarized findings and may develop recommendations… more
- Molina Healthcare (Austin, TX)
- **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
- Molina Healthcare (Austin, TX)
- **JOB DESCRIPTION** **Job Summary** Performs research and analysis of complex healthcare claims data, pharmacy data, and lab data regarding network utilization ... and cost containment information. Evaluates, writes, and presents healthcare utilization and cost containment reports and makes recommendations based on relevant findings. **KNOWLEDGE/SKILLS/ABILITIES** + Develop ad-hoc reports using SQL programming, SQL… more
- Molina Healthcare (Austin, TX)
- …+ 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 (Austin, TX)
- …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
- Baylor Scott & White Health (Austin, TX)
- …analytics to support our organization. We seek a stakeholder-facing statistical analyst that will be responsible for the extraction, analysis and interpretation ... of cost saving initiatives. Partnering with their Manager and peers to research and investigate current and new utilization trends with meaningful statistical… more
- Prime Therapeutics (Austin, TX)
- …and value of those standards. + Oversees and/or participates in the research and evaluation of new business intelligence, analytics and/or data visualization ... + Prior experience as a Business Intelligence Developer or Data Analyst supporting business intelligence, reporting, analytics or data warehouse projects. +… more