- Idaho Division of Human Resources (Boise, ID)
- Medicaid Utilization Review Analyst - DMS Posting Begin Date: 2024/09/27 Posting End Date: 2024/10/20 Category: Accounting and Finance Sub Category: ... you. The Division of Management Services is hiring aMedicaid Utilization Review Analystat ourBoiselocation.This position is instrumental...identify and deter fraud, waste and abuse in the Medicaid program. As an analyst , you will… more
- State of Georgia (Fulton County, GA)
- Budget and Financial Analyst - Office of Medicaid Coordination and Health Systems Innovation (OMC/HSI) Georgia - Fulton - Atlanta ... downtown Atlanta. Job Description Job Title: Budget and Finance Analyst , Office of Medicaid Coordination and Health...DBHDD budget and finance team and programmatic officers to review monitor utilization trends and financial outputs… more
- Teva Pharmaceuticals (Parsippany, NJ)
- Medicaid Claims Analyst Date: Sep 22, 2024 Location: Parsippany, United States, New Jersey, 07054 Company: Teva Pharmaceuticals Job Id: 57268 **Who we are** Teva ... us on our journey of growth! **The opportunity** The Medicaid Claims Analyst is responsible for ...propose recommended amounts to be paid for historical outstanding utilization that is routinely submitted with Medicaid … more
- Humana (Columbus, OH)
- …provide best estimate utilization /PMPMs for the month close process + Refresh Medicaid Front End Review tool monthly and communicate results + Prepare ... estimates admit count and spend for each of Humana's Medicaid states. The analyst calculates inpatient trends, exercises actuarial judgement to determine which… more
- The Cigna Group (Bloomfield, CT)
- **Cigna Medicare Part C Appeals Reviewer: Appeals Processing Analyst ** We will depend on you to communicate some of our most critical information to the correct ... Medicare appeals and related issues, implications and decisions. The Case Management Analyst reports to the Supervisor/Manager of Appeals and will coordinate and… more
- MyFlorida (Tallahassee, FL)
- …rules, coverage policies, managed care plan contracts, bill analyses, drug utilization review boards, preferred drug lists, supplemental rebate contracts, ... 68064844 - MEDICAL/HEALTH CARE PROGRAM ANALYST Date: Sep 19, 2024 The State Personnel...entity. The Agency is responsible for administering the Florida Medicaid program, the licensure and regulation of nearly 50,000… more
- MyFlorida (Tallahassee, FL)
- …rules, coverage policies, managed care plan contracts, bill analyses, drug utilization review boards, preferred drug lists, supplemental rebate contracts, ... 68064814 - GOVERNMENT ANALYST II Date: Sep 20, 2024 The State...be found on the Agency's administrative rule webpage at http://ahca.myflorida.com/ medicaid / review /index.shtml. 8. Providing technical assistance to ensure… more
- Commonwealth Care Alliance (Boston, MA)
- …claims adjudication, clinical coding reviews for claims, settlement, claims auditing and/or utilization review required + 7+ years experience with Optum Claims ... research, as necessary on all new and revised coding logic, related Medicare/ Medicaid policies for review /approval through the Payment Integrity governance… more
- Commonwealth Care Alliance (Boston, MA)
- …claims adjudication, clinical coding reviews for claims, settlement, claims auditing and/or utilization review required + Extensive knowledge and experience in ... Management and Claims Compliance, the Payment Integrity (PI) Recovery Analyst will assist in the development of a strategic...strategies to prevent future occurrences, with the ability to review impacts holistically. + Assist in the development of… more
- Kelsey-Seybold Clinic (Houston, TX)
- …ICD9 Coding and billing. Demonstrate strong working knowledge of Payor Contracts, Utilization Review procedures (specific to authorizations). Able to interpret ... Essential job functions include: Apply knowledge of Centers for Medicare & Medicaid Services (CMS) rules specific to DRG pricing methods, APC, Outpatient Prospective… more
- The Cigna Group (Bloomfield, CT)
- …preferred + 5+ years of experience is preferred in prior authorization or utilization review and appeals + Demonstrated proficiency with Microsoft Office ... Nurse Case Management Lead Analyst -Nurse Clinician - Accredo Job Description Summary The...years of experience is preferred in prior authorization or utilization review and appeals + Demonstrated proficiency… more
- State of Minnesota (St. Paul, MN)
- …of SWIFT accounting to MMIS and federal reporting entries for the CMS64. + Review and analyze biweekly fund code utilization for any outliers that could ... **Working Title: Health Care Accounting (HCA) Quality Control Analyst ** **Job Class: Accounting Officer Senior** **Agency: Human Services Dept** + **Job ID** : 80375… more
- Spokane County (Spokane, WA)
- …reports for review by CSD leadership for effective management of utilization and performance measurements and goals. + Documents the electronic data information ... Data Information Analyst (OPEN & PROMOTIONAL) Print (https://www.governmentjobs.com/careers/spokanecountywa/jobs/newprint/4658590) Apply Data Information … more
- CAI (Harrisburg, PA)
- …Consultant, you will analyze and support business operating decisions related to Medicaid , Managed Care, and other health and human services programs **Job ... a HHS Consultant to analyze and support business operating decisions related to Medicaid , Managed Care, and other health and human services programs. This position… more
- The County of Los Angeles (Los Angeles, CA)
- …program administration, ensuring compliance with Federal and State Medicare and Medicaid regulations for reimbursement claiming and maximum recovery costs for ... goals. Develops and implements reporting procedures to ensure that program services utilization and revenue data are reported accurately and in a timely manner.… more
- Ascendis Pharma (Princeton, NJ)
- …forecasting analyses, and reporting for all GTN line items. + Assist with the review of monthly GP utilization files (GP rebate claims), 340B | PHS ... for best-in-class efficacy and safety. The Government Pricing and Gross-to-Net Analyst is responsible for managing and analyzing pricing strategies and financial… more
- Alameda Health System (Alameda, CA)
- …and a resolution is initiated and presented weekly at Medicare or Utilization Review meetings. **MININUM QUALIFICATIONS** : Education: Graduate of accredited ... transportation; and referring personal payment issues to the Financial Analyst as soon as possible to minimize reimbursement. Obtains...all staff in the RAI Process, Case-Mix, PPS Medicare, Medicaid , and the clinical computer system in relation to… more