- Molina Healthcare (Akron, OH)
- …+ Develop custom health plan reports related to managed care data like Medical Claims , Pharmacy, Lab and HEDIS rates + Assists and collaborates with the national ... Risk and Quality department with testing of pre-production reporting for the assigned health plan + Calculate and track gap closure and intervention outcome reporting for the assigned state + Work in an agile business environment to derive meaningful… more
- Molina Healthcare (Columbus, OH)
- …supervised learning and rule-based logic to detect potentially incorrectly paid claims . + Contribute to improve data quality, perform data audits, identify ... discrepancies and resolve issues. + Support the identification of opportunities for operational improvement or growth based on analytical findings. + Areas of exposure may include: + Economics/Finance + Data Analysis / Science + Fraud, Waste, and Abuse… more
- Molina Healthcare (Dayton, OH)
- …focused reviews and recommends corrective actions. + Conducts retrospective reviews of claims and appeals and resolves grievances related to medical quality of care. ... + Attends or chairs committees as required such as Credentialing, P&T and others as directed by the Chief Medical Officer. + Evaluates authorization requests in timely support of nurse reviewers; reviews cases requiring concurrent review, and manages the… more
- Molina Healthcare (Cleveland, OH)
- …Architectural compliance and governance. **Knowledge/Skills/Abilities** + Healthcare knowledge in Claims Processing and Payments + Develops software (hands on code ... development) to meet key business objectives. + Understands and applies SW and applications development methodologies in adherence to SW development standards + Designs and develops SW applications or systems solving specific business or processing problem… more
- Molina Healthcare (Columbus, OH)
- …**I** **E** **N** **C** **E:** + 1 year of Molina experience, health claims experience, OR one year of customer service/provider service experience in a managed ... care or healthcare environment. + Strong verbal and written communication skills. To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing. Molina Healthcare offers a competitive… more
- Medtronic (OH)
- …Clinical Expert + Translates complex technical messaging, dispels competitive claims , resolves complex technical issues, and maintains customer relationships through ... technical expertise + Understands, interprets, and participates in communication of product and procedure updates and field corrective actions pertinent to Medtronic products and therapies + Collaborates with clinical research organization relative to clinical… more
- Norstella (Columbus, OH)
- …in Product Marketing or Product Management; experience with real-world data ( claims , labs, EMR/EHR, Rx, hub/specialty pharmacy) strongly preferred. * Proven ability ... to turn technical concepts into compelling, concise messaging and content. * Executive-ready communicator; excellent writing and PowerPoint. * Comfortable in fast-moving, cross-functional environments; bias to action. * Pragmatic Institute or PMA certification… more
- Meta (Columbus, OH)
- …and CW Schedulers for Delay Tracking, Extension of Time (EOT) requests and claims and coordinate the change evaluation in collaboration with the cost team. ... Responsible for making recommendations that are in line with contract and escalating when site decisions differ from the contractual or program guidance 3. Support Precon team in ensuring that the GC/TC establishes a baseline that is aligned with precon… more
- Dayton Children's Hospital (Dayton, OH)
- …1-2 years of billing experience in hospital and/or professional billing, including claims filing and reconciliation, payment posting, CPT and coding experience as ... well as direct patient service experience is required + 3+ years of patient access and billing experience is preferred Certification: + Epic certification in Resolute HB or PB is preferred Skills: + Proficiency in Microsoft Office Suite required + Strong… more
- Prime Therapeutics (Columbus, OH)
- …in federal healthcare laws and regulations such as HIPAA, Anti-Kickback Statute, and False Claims Act, with a focus on PBM and managed care operations + Experience ... engaging with regulatory bodies (eg, CMS, OIG, state pharmacy boards) and contributing to internal or external policy initiatives Every employee must understand, comply with and attest to the security responsibilities and security controls unique to their job,… more