- The MITRE Corporation (Mclean, VA)
- …to make, then choose MITRE-and make a difference with us. MITRE is seeking experienced healthcare claims data analysts with the ability to develop expertise ... working comfortably in team settings. This position requires significant experience with CMS claims data and the ability to design studies and analyses,… more
- Healthfirst (VA)
- …and existing reporting tools, databases, and processes + Analyze various types of data and processes in a versatile manner and professionally present findings and ... recommendations + Query via SQL, Python, Tableau (Prep), Alteryx and manipulate data to root cause, trend, summarize findings, and offer recommendations. +… more
- Highmark Health (Richmond, VA)
- …how design of these programs creates financial value for the enterprise. + Interprets raw claims , provider, quality, and member data to build data sets for ... help guide and design programs and initiatives. Performs innovative data modeling and routinely partners with data ...work experience **Preferred** + 3 years of Insurance or healthcare work experience **SKILLS** + Analytic Judgement +… more
- Prime Therapeutics (Richmond, VA)
- …+ Recommend new and revised financial pricing programs based on analysis of pharmacy claims data , average wholesale drug prices (AWP), and other relevant data ... data + Develop financial pricing models to monitor performance against pharmacy claims data and identify financial pricing opportunities to drive savings… more
- Elevance Health (Norfolk, VA)
- … processing experience is preferred. + 2+ years of experience with data analysis, claims processing, provider billing, FWA investigations, cost containment, ... **Business Analyst II** **Location** : This position will work...+ Request and/or run queries as needed to retrieve data . + Meet with various business partners as needed.… more
- VHC Health (Arlington, VA)
- Senior Epic Resolute Hospital Billing Analyst II Job Description Purpose & Scope: This position is responsible for leading, coordinating, and supporting the ... overall coordination of team activities. The Senior Resolute Hospital Billing Analyst provides deep application understanding and displays excellent verbal and… more
- Humana (Richmond, VA)
- …and independent determination of the appropriate courses of action. The Actuarial Analyst 2, Analytics/Forecasting ensures data integrity by developing and ... of our caring community and help us put health first** The Actuarial Analyst 2, Analytics/Forecasting analyzes and forecasts financial, economic, and other data … more
- Elevance Health (Richmond, VA)
- **Provider Contract/Cost of Care Analyst Senior-Analytics** **Location:** This position will work a hybrid model (remote and office). Must live within 50 miles/1 ... Analytics and Optimization team** is looking for a senior analyst who will lead medical cost trend deep dives...Care and/or Provider Contracting organizations. Focuses efforts on lowering claims costs, improving the quality of care, and increasing… more
- Navy Exchange Services (NEX) (Virginia Beach, VA)
- Title: Retail Fraud/Security Analyst (Asset Protection/Safety) Location: United States-Virginia-Virginia Beach Job Number: 240000JD Navy Exchange Service Command ... members. A few of our benefits include: ⭐ Federal Healthcare ⭐ Dental, Vision, 401(k) & Pension Plan ⭐...exception reports based on concepts. Validates and analyzes department data by cross-referencing and checking data points;… more
- TEKsystems (Arlington, VA)
- …to plan. 8. Responsible for delivery of application technology solutions and data information planning effort. 9. Coordinates and manages on-call support and owns ... Work Experience: 1. 8+ years of experience as an analyst working in NextGen on the Billing Module. Must...Module. Must have experience working on solution design for Claims processes in NextGen, including payer, provider, groups, and… more
- Prime Therapeutics (Richmond, VA)
- …we make. **Job Posting Title** Documentation Management & Reporting Business Analyst - Louisiana Medicaid **Job Description Summary** Serves as liaison between ... departmental team business owners, end users, IT, Claims and Clinical departments. Responds to ad hoc requests for support, reports and analysis. Supports… more
- Deloitte (Mclean, VA)
- …wants to work in a collaborative environment? As an experienced Epic Tapestry Application Analyst you will have the ability to share new ideas and collaborate on ... plans. + Understand health plan regulatory requirements for AP Claims , Authorizations, Capitation, Accounts Payable, and Enrollment using Tapestry modules.… more
- Highmark Health (Richmond, VA)
- …+ 2 years of Coding languages, analytical software, systems, tools and processes using claims , clinical, enrollment and provider data + 1 year of Project ... :** Highmark Health **Job Description :** **JOB SUMMARY** This job creates data -driven insights which identify actionable opportunities aligned to the Quadruple Aim… more
- HCA Healthcare (Salem, VA)
- …and process documentation for both the department and for assigned projects + Perform data analyst functions that generate knowledge via data mining, ... GME is a relatively new service line within HCA Healthcare . The group is expected to grow substantially over...records, Medicare claims , or other health care claims data sets preferred. + SAS, R,… more
- Highmark Health (Richmond, VA)
- …quotes and analyzes the structure of a contract for a group based on claims experience, characteristics of the employee groups, etc. The incumbent uses discretion of ... policies, practices, and standards. Analyzes associated policies, guidelines, market data to continuously improve risk management and gain appropriate enrollment… more
- Evolent Health (Richmond, VA)
- …datasets and Evolent Data Warehouse tables, including medical, pharmacy and ancillary claims data , membership data , clinical operational data (UM ... solve complex business problems. **Collaboration Opportunities** The Director, Client Analyst role will be serving as a strategic advisor...& CM), or other healthcare data - **Required.** + Familiarity with Power BI or BI… more
- Highmark Health (Richmond, VA)
- …new plans/providers. Translates configuration rules, fee schedules, contract terms, provider data code sets, and benefits into systems parameters to ensure accurate ... managed care operations (ie enrollment & billing, claims processing, etc.). This job supports one or more analytical aspects of the application product life cycle,… more
- Prime Therapeutics (Richmond, VA)
- …analysis to include 5 years of experience in Pharmacy Benefit Management (PBM), claims processing, healthcare , and/or related field + 3 years of experience ... Title** Network Economic Financial Consultant **Job Description** The Principal Pricing Analyst leads complex analyses, financial modeling, and reporting to create… more