- The Cigna Group (Franklin, TN)
- **Summary** The Data Scientist Lead Analyst will contribute to the Medicare Clinical and Customer strategy, performing research and analysis within the ... STARS, and Risk Adjustment Analytics team. Reporting to the Senior Manager of Clinical & Customer Data ...strategic insights, and collaboration with our internal partners. The Data Scientist Lead analyst will interface across… more
- Molina Healthcare (UT)
- …on claims databases. Maintains critical information on claims databases. Synchronizes data among operational and claims systems and application of business rules ... as they apply to each database. Validate data to be housed on databases and ensure adherence...existing health plans. + Must have experience working on QNXT/ Medicare /NetworX + Must have experience working on SQL. +… more
- Medical Mutual of Ohio (Brooklyn, OH)
- …departments, ensuring financial processes are efficient and aligned with company goals. Sr Financial Analyst Responsible for analyzing financial trends, creating ... close process and project reporting. **.** **Performs other duties as assigned** ** Sr . Financial Analyst ** . Supports financial analysis on company… more
- Commonwealth Care Alliance (Boston, MA)
- …. Director, TPA Management and Claims Compliance, Healthcare Medical Claims Coding Sr . Analyst will be responsible for developing prospective claims auditing ... ensure that the applicable edits are compliant with applicable Medicare and Massachusetts Medicaid regulations. The role will also...and report outcome results on edits implemented. + Utilize data to examine large claims data sets… more
- Prime Therapeutics (Columbus, OH)
- …our passion and drives every decision we make. **Job Posting Title** Claims Technical Analyst , Sr . **Job Description** The Senior Claims Technical Analyst ... efforts for department level applications. **Responsibilities** + Serve as lead Analyst for complex and/or escalated analysis requests; coordinate requests from… more
- Providence (WA)
- …retain the best people, we must empower them._** **Providence Health Plan is calling a Senior Actuarial Analyst , Medicare Bid who will:** + Be responsible ... for developing and maintaining actuarial models, analyzing data , and providing strategic insights to support the pricing...to support the pricing and bidding process for our Medicare Advantage plans + Have a deep understanding of… more
- Medical Mutual of Ohio (Brooklyn, OH)
- …activities. May include the collection, preparation, review, and submission of information, data , and documents to Medicare Advantage Compliance Officer or ... self-funded group coverage, including stop loss, as well as Medicare Advantage, Medicare Supplement, and individual plans..... Working knowledge of SQL, QMF, and or other data extract methods. Medical Mutual is looking to grow… more
- Point32Health (Boston, MA)
- …Point32Health, click here (https://youtu.be/S5I\_HgoecJQ) . **Job Summary** This Senior Actuarial Analyst will support the Medicare Part C Pricing work. The ... key responsibilities for this role are pricing, rate filing ( Medicare Advantage Bid) development, strategic analysis, and other ad...fit changing needs. + Create code to pull in data needed for various models. Validate and audit the… more
- Molina Healthcare (AZ)
- …DESCRIPTION** **Job Summary** Analyzes complex business problems and issues using data from internal and external sources to provide insight to decision-makers. ... Constructs forecasts, recommendations and strategic/tactical plans based on business data and market knowledge. Creates specifications for reports and analysis… more
- Robert Half Management Resources (Brockton, MA)
- Description We are in search of a Sr . Financial Analyst to join our team in Brockton, Massachusetts. In this role, you will be tasked with various external and ... the preparation of various external and regulatory reports, including Medicare 2552, CHIA cost reports, and RFA reporting *...analysis * Utilize business systems and CRM tools for data mining and report generation * Leverage skills in… more
- Molina Healthcare (AZ)
- **JOB DESCRIPTION** **Job Summary** The Senior Analyst , Medical Economics provides support and consultation to the Health Plan and Finance team through analyzing ... creating tools to monitor trend drivers and provide recommendations to senior leaders for affordability opportunities. Responsible for conducting complex analyses of… more
- Sanford Health (SD)
- …and support to all operating segments across Sanford. Responsible to review Medicare /Medicaid documentation to assist nursing centers in completing minimum data ... set (MDS) documentation to assure appropriate levels of Medicare and/or Medicaid reimbursement. Works with executive leadership, administrators, and facility staff… more
- American Academy of Pediatrics (Itasca, IL)
- …research, policy analysis, and medical liability/risk management. Reporting to the Sr Director, Child Health Financing Strategy, this role will research, develop, ... that impact pediatric healthcare financing, particularly those related to Medicaid, Medicare , value-based care arrangements, and other government programs such as… more
- Healthfirst (NY)
- …support to network management department and our owner hospitals. + Pull data from warehouse using Statistical Analysis System (SAS)/Structured Query Language (SQL) ... community. + Keep abreast of New York Medicaid and Medicare reforms and their impact on the health plan...Excel Skills (Pivot Table Creation, Complex formula development) + Data Visualization Experience (Tableau or Qlik View or, Power… more
- The Cigna Group (Philadelphia, PA)
- Performs actuarial analyses for Medicare Advantage business, including, but not limited to: medical expense analyses and projections, financial forecasts, ... Medicare Part C bid development, regulatory (CMS) filings, actuarial...market-specific initiatives. + Communicating results of analyses to more senior actuarial team members. + Actively participate in team… more
- Medical Mutual of Ohio (Brooklyn, OH)
- …fully insured and self-funded group coverage, including stop loss, as well as Medicare Advantage, Medicare Supplement, and individual plans. Medical Mutual' s ... cash deposits via next day banking reports and Accounts Receivable system data queries. Payment Control Specialist II Processes routine to moderately complex… more
- Healthfirst (NY)
- …and maintain monthly competitive reports + Prepare ad-hoc reporting as required by senior management and external partners + Support team in creation of models to ... trends and identifying drivers + Ability to efficiently validate data and analyses to identify potential errors in final...system or a health insurance company + Knowledge of Medicare and Medicaid programs, health care, and managed care… more
- Humana (Columbus, OH)
- **Become a part of our caring community and help us put health first** The Senior Data and Reporting Analyst / Professional generates ad hoc reports and ... or data warehouse queries and scripts. The Senior Data and Reporting Analyst ...recognized leader in healthcare delivery that has been offering Medicare Advantage health plans in Florida over 23 years.… more
- Lucile Packard Children's Hospital Stanford (Palo Alto, CA)
- …and purpose of the job. Reporting to the Director of Physician Revenue Cycle, the Senior Revenue Cycle Analyst ( Sr . RCA) is both a transformational leader ... and an analyst . The Sr . RCA has an in-depth...Children?s Healthcare Alliance (PCHA) and hospital revenue cycle. The Senior Revenue Cycle Analyst will collaborate with… more
- Ventura County (Ventura, CA)
- Behavioral Health Finance Analyst I/II/ Senior Print (https://www.governmentjobs.com/careers/ventura/jobs/newprint/4617164) Apply Behavioral Health Finance ... Analyst I/II/ Senior Salary $75,660.36 - $129,463.29 Annually Location Oxnard, CA...State and federal entities; + Extracts and works with data from databases to establish revenue by program; +… more