- Evolent (Atlanta, GA)
- …data using industry-standard metrics. + Process and validate raw unadjudicated claims data . **Qualifications Required and Preferred:** + Bachelor's degree, ... presentations. + Perform research and analysis of complex healthcare claims , eligibility, and pharmacy data to make...of complex healthcare claims , eligibility, and pharmacy data to make recommendations based on relevant findings. +… more
- Highmark Health (Atlanta, GA)
- …business unit needs. May troubleshoot errors, conduct impact analyses, and/or solve data rejection. Performs business analyses in one or more operational areas. ... 3 - 5 years of experience in a Business Analyst or Business Process Analyst role or...role or experience in a related operational area (eg claims , billing, customer service, etc.) **Preferred** + 1 -… more
- Molina Healthcare (Macon, GA)
- …solutions. + Write advanced SQL queries to extract, validate, and analyze healthcare data , including claims , pharmacy, and lab datasets. + Build and maintain ... **JOB DESCRIPTION** **Job Summary** JOB SUMMARY: The Sr. Analyst , Healthcare plays a critical role in supporting clinical and operational initiatives by translating… more
- AIG (Atlanta, GA)
- …the way we help customers to manage risk. Join us as an Actuarial Analyst -Warranty to play your part in that transformation. It's an opportunity to grow your ... mark in Actuarial We are looking for an Actuarial Analyst to join the AIG Warranty Service Programs Actuarial...Actuarial Department works closely with the management, underwriting, and claims and is involved in a wide range of… more
- Emory Healthcare/Emory University (Atlanta, GA)
- …aligns with the university calendar. JOB DESCRIPTION: + Board Certified Behavioral Analyst (BCBA) II (Behavioral Clinical Practitioner BCPII ) in the Emory Autism ... as the provider on record for appropriate managed care intervention claims with responsibility for appropriate documentation, implementation, monitoring, and billing… more
- Intermountain Health (Atlanta, GA)
- **Job Description:** The Business Analyst II reports to the Supervisor of the Central Business Unit (CBU) and performs moderate to complex tasks within our claims ... York, Rhode Island, Vermont, and Washington. **Minimum Qualifications** + 5-8 years claims processing or system set-up experience, managed care preferred + High… more
- Humana (Atlanta, GA)
- …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
- CVS Health (Atlanta, GA)
- …with heart, each and every day. **Position Summary** The Dispute Repricing Analyst will be responsible for the accurate analysis and resolution of provider ... and responding to provider participation and pricing inquiries. + Analyze post-paid healthcare claims as it relates to pricing needs. + Apply in-depth research to… more
- Molina Healthcare (Augusta, GA)
- …all claims and provider databases. Maintains critical provider information on all claims and provider databases. Synchronizes data among multiple claims ... systems and application of business rules as they apply to each database. Validate data to be housed on provider databases and ensure adherence to business and… more
- Emory Healthcare/Emory University (Atlanta, GA)
- …and the Charge Generation Tracker (CGT) Matrix files that contain the charge generating data for all active charges currently maintained in our CDM of Technical and ... claim edits/rejections. + Works daily Charge Reconciliation, Charge Review and other DNB/ Claims work queues specifically assigned to resolve bill holds for charge… more