- The Cigna Group (Nashville, TN)
- …In addition to identifying root causes of quality and accuracy issues, they will provide technical support and coaching for our data stewards. The data ... project. They will help to drive improvements in the provider data domain to ensure we meet...assisting with improved claims auto-adjudication. + Work within the Data Quality management process to champion incremental… more
- The Cigna Group (Bloomfield, CT)
- …ensure the accuracy of provider data , including regular audits of provider directory and sourcing of high- quality data from providers and third-party ... vendors to ensure that data in the provider directory is high- quality and up-to-date. **KEY... provider directory operations, network management, and/or healthcare data management. Experience with Medicare Advantage is… more
- The Cigna Group (Bloomfield, CT)
- …+ Serve as the subject matter expert on all regulations relevant to the Medicare provider directory and network adequacy, providing guidance to internal teams on ... **OVERVIEW** The Senior Manager of Medicare Advantage Provider Directory Vendor and...& Medicaid Services) requirements, and NCQA (National Committee for Quality Assurance) requirements + Lead the preparation and submission… more
- TEKsystems (Salt Lake City, UT)
- …guidance walking through program details, requirements, and how to successfully report their Medicare Quality Reporting data via the appropriate CMS ... patients are subject to various CMS (The Centers for Medicare and Medicaid) Quality Reporting programs. These...is the Customer Experience. We aim to serve the Medicare and healthcare communities as educators who provide… more
- Highmark Health (Harrisburg, PA)
- …are met or exceeded. Further, in a matrix management environment, the Medicare Advantage Quality Consultant is responsible for collaborative work with ... other functions in the provider area, data analytics, and key internal/external...HEDIS and risk revenue programs and clinical evidence-based guidelines.The Medicare Advantage Quality Consultant is expected to… more
- The Cigna Group (Denver, CO)
- **Summary** The Medicare Advantage Data Science team's mission is to provide data science and analytical support to our partners, promote sustained ... collaboration with our Cigna matrix partners. This role will provide Medicare Advantage clinical and member experience...development programs and on a project-by-project basis + Ensure quality and integrity of data collected, analyses… more
- Medical Mutual of Ohio (Brooklyn, OH)
- …advanced statistical methodology including conjoint, max diff, regression analysis to provide data -driven conclusions. + Collaborates with other team members ... of the Medicare Advantage. This role supports Medicare product management by evaluating data trend...trusted by businesses and nonprofit organizations throughout Ohio to provide high- quality health, life, disability, dental, vision… more
- The Cigna Group (Denver, CO)
- …critical processes + Develop reporting in collaboration with analytics partners to monitor data quality + Work effectively and efficiently on multiple tasks and ... **Summary** The Medicare Risk Adjustment Advanced Analytics team is searching...while producing high quality results + Ensure quality and integrity of data and follow… more
- USAA (Tampa, FL)
- …currently seeking a dedicated **Business Process Owner Senior** that will support Medicare Supplement Claims for USAA Life Company Claims Operations. This employee ... the Life Company Chief Claims & Fraud Officer and will work on Medicare Supplement Claims activities and ensure a flawless execution of business-related processes,… more
- The Cigna Group (Bloomfield, CT)
- …representing over 40% of Cigna's total medical cost savings. The **NANPM Medicare Senior Advisor** is responsible for negotiating Medicare Supplemental ... NANPM Management Process, supports implementation of strategic priorities, and provides data and information to maximize value. This role collaborates with Vendor… more
- Medical Mutual of Ohio (OH)
- …all attempts in tracking software. . Collaborates with Clinical Intervention Pharmacists on Medicare Stars and other quality initiatives, with a strong focus on ... all attempts in tracking software. . Collaborates with Clinical Intervention Pharmacists on Medicare Stars and other quality initiatives, with a strong focus on… more
- The Cigna Group (Nashville, TN)
- …experience in healthcare analytics; value-based care experience preferred + Experience with government medicare data highly desired + Data extraction and ... quality of care of our members by our provider groups. In addition, this person will be responsible...collaboratively with key technical and non-technical matrix partners to provide analytical reporting for use in evaluation of our… more
- Fallon Health (Worcester, MA)
- …improving health and inspiring hope, we strive to be the leading provider of government-sponsored health insurance programs-including Medicare , Medicaid, and ... Founded in 1977 in Worcester, Massachusetts, Fallon Health delivers equitable, high- quality , coordinated care and is continually rated among the nation's top… more
- The Cigna Group (Plano, TX)
- …an individual contributor responsible for supporting the analytics strategy for Medicare Health Services, performing research and analysis within the Clinical ... team. This role will help us accomplish this through data -driven analytics, strategic insights, and collaboration with our internal...to meet our goal of reducing costs and increasing quality of care to our members. This individual will… more
- Ascension Health (Indianapolis, IN)
- …organizations, and other customers. + Coordinate efforts for treatment and promote quality improvement and educational efforts. + Compile data , track outcomes, ... **Details** + **Department:** Medicare Wellness + **Schedule:** Monday-Friday 8a-5p + **Hospital:**...and makes recommendations for process improvement. + Provide referrals/support for follow-up care for patients who are… more
- UCLA Health (Los Angeles, CA)
- …more at UCLA Health. You will be responsible for accurate and timely data entry, and the review and adjudication of professional, ancillary, and institutional claims ... or other methods, you will be called on to meet established quality , productivity, service level, and turn-around requirements. This role requires the ability… more
- Humana (Clearwater, FL)
- …they need, when they need it. These efforts are leading to a better quality of life for people with Medicare , Medicaid, families, individuals, military service ... community and help us put health first** The Senior Data and Reporting Analyst / Professional generates ad hoc...bi-weekly payment for their internet expense. + Humana will provide Home or Hybrid Home/Office associates with telephone equipment… more
- Medical Mutual of Ohio (OH)
- …physician and practice engagement in quality improvement initiatives and outcomes. . Provide quality assurance of provider rate loading. . Performs other ... financial analysis. Maintains market intelligence and analyzes network performance to provide Provider Engagement with consultative and analytical insights. .… more
- Medical Mutual of Ohio (OH)
- …maintenance documents into document management system. Research and/or routes issues to the Provider Data area and workflow queues for resolution. + Answers ... and maintenance documents into document management system.Research and/or routes issues to the Provider Data area and workflow queues for resolution. + Answers… more
- Medical Mutual of Ohio (OH)
- …coverage, including stop loss, as well as Medicare Advantage, Medicare Supplement, and individual plans. **Responsibilities** ** Provider Analyst II** ... guides, and monitors, as well as performs, the analytical review of opportunities with provider networks. . Performs strategic data analysis ( data mining)… more