- Evolent (Columbus, OH)
- …data using industry-standard metrics. + Process and validate raw unadjudicated claims data. **Qualifications Required and Preferred :** + Bachelor's degree, ... such as DRGs, Revenue Codes, CPT Codes, RVUs, bundled payments, etc. is preferred + Working knowledge of healthcare claims ; specifically, differences between… more
- Medical Mutual of Ohio (OH)
- **Note: this is a fully remote opportunity.** **Eastern Time Zones preferred .** Founded in 1934, Medical Mutual is the oldest and one of the largest health insurance ... related field. . 3 years' experience as a HEDIS Quality Improvement Analyst or equivalent HEDIS analytical project experience. programs. **Technical Skills and… more
- Prime Therapeutics (Columbus, OH)
- …and drives every decision we make. **Job Posting Title** IT Business Systems Analyst - ScriptMed - Remote **Job Description** The IT Business Systems Analyst ... willing to receive work direction from direct and indirect leadership ** Preferred Qualifications** + Previous Pharmacy Benefit Management (PBM) or healthcare… more
- Humana (Columbus, OH)
- …and help us put health first** The Medicaid (PPS) Provider Hospital Reimbursement Analyst also known as a Senior Business Intelligence Engineer will be an integral ... closely with IT, the pricing software vendor, CIS BSS, Medicaid operations, claims operations, and other business teams involved in the administration of Medicaid… more
- Cleveland Clinic (Cleveland, OH)
- …of the most respected healthcare organizations in the world. As a Senior IT Business Analyst , you will play a key role in bridging the gap between business needs and ... + Strong analytical, problem solving, and communications skills are required. Preferred qualifications for the ideal future caregiver include: + Certifications from… more
- Molina Healthcare (Dayton, OH)
- …for accurate and timely maintenance of critical provider information on all claims and provider databases. Maintains critical provider information on all claims ... that provider information is loaded accurately to allow for proper claims processing, outbound reporting and directory processes. **JOB QUALIFICATIONS** **Required… more
- Cleveland Clinic (Cleveland, OH)
- …role, every member of the Cleveland Clinic team is a caregiver. Serving as Systems Analyst IV, being a caregiver starts in the office, where you will apply your ... project management skills + Understanding of principles of client/server configuration Preferred qualifications for the ideal future caregiver include: + EPIC… more
- Molina Healthcare (Dayton, OH)
- **JOB DESCRIPTION** **Job Summary** JOB SUMMARY: The Sr. Analyst , Healthcare plays a critical role in supporting clinical and operational initiatives by translating ... advanced SQL queries to extract, validate, and analyze healthcare data, including claims , pharmacy, and lab datasets. + Build and maintain efficient ETL pipelines… more
- Cleveland Clinic (Cleveland, OH)
- …healthcare organizations in the world. As an Epic Billing Systems Analyst , you will assist with feasibility analysis, estimating, planning, designing, developing, ... critical thinking, communication, problem solving and relationship building skills Preferred qualifications for the ideal future caregiver include: + Bachelor's… more
- CVS Health (Columbus, OH)
- …not limited to termination requests, tax id changes, hold requests, claim reimbursement, system, directory accuracy and various contractual issues. Documented ... all parties. Presentation of DHMO and PPO plan design, compensation process, claim / encounter submission, and referral policies during new office orientations and… more