- Healthfirst (TN)
- …in a simple and easy to understand manner to other staff. As the SME, the Claims Configuration Analyst will need to effectively communicate with all levels ... Assist in the setup of code sets and defining pre-authorization guidelines used in claims configuration to drive application of medical policy and accurate … more
- Healthfirst (TN)
- …products, claims editing, reference data and their enhancements including claims configuration improvements, compliance and systems enhancements. + Follow ... the annual product development processes to manage major claims configuration projects, including claims business rule set up outlier management. + Interpret… more
- Healthfirst (TN)
- … business rules within the claims processing system. + Identify claims configuration and contract implementation defects and improve departmental performance ... specifications and ensure proper system functionality and quality outcomes including claims configuration , provider set up, reimbursement methodology and core… more
- Intermountain Health (Nashville, TN)
- **Job Description:** As a Business Systems Analyst , you will work closely with the business areas to identify and understand their needs and requirements. The major ... to major projects. Requirements may be specific to healthcare insurance products, claims , sales activities or other service-related processes; all in support of… more
- HealthEdge Software Inc (Nashville, TN)
- …implementing proprietary healthcare edits that drive cost savings and accuracy in claims processing. The successful candidate will be responsible for taking a senior ... level role in analyzing claims data, as well as translating contract terms, policies,...features Medicare and Medicaid content coupled with flexible contract configuration capabilities for Commercial lines of business. Payment Integrity… more
- Evolent (Nashville, TN)
- …a deep understanding of end user outputs, platform development & configuration , multisystem functional requirements, business rules, and leverage that knowledge to ... + 5-8+ years of IT and / or business experience in an HMO / PPO Claims , Medicaid, Medicare and / or managed care healthcare environment + Knowledge of the Affordable… more