- Highmark Health (Columbus, OH)
- …efforts. Daily responsibilities will involve the in-depth analysis of complex healthcare claims data utilizing advanced analytical techniques to detect ... analytical strategies. - Develop and optimize SQL queries to extract data from healthcare claims databases. - Analyze large datasets of healthcare claims … more
- Evolent (Columbus, OH)
- …Codes, CPT Codes, RVUs, bundled payments, etc. + Working knowledge of healthcare claims ; specifically, differences between institutional vs professional billing ... to our culture. **What You'll Be Doing:** + Lead in-depth analyses of healthcare data - including authorizations, claims , membership, and clinical outcomes to… more
- Humana (Dayton, OH)
- …JD, MSN, Clinical Certifications, CPC, CCS, CFE, AHFI) + Understanding of healthcare industry, claims processing and investigative process development + ... closely with internal and external auditors, financial investigators, and claims processing areas + Adequately staff and manage the...reside in Ohio + At least 2 years of healthcare fraud investigations and auditing experience + Knowledge of… more
- Elevance Health (Mason, OH)
- …years at the executive level. + Proven track record of delivering large-scale healthcare technology solutions ( claims systems, care management platforms, or cost ... for building advanced analytics platforms, AI/ML-driven decision support tools, claims optimization systems, and clinical insights platforms that enable Elevance… more
- Evolent (Columbus, OH)
- …seamlessly with diverse teams and stakeholders. + Deep understanding of healthcare claims , reimbursement methodologies, and cost/utilization KPIs, including ... preferred. + 10+ years of analytics & reporting experience in healthcare , including medical economics, cost/utilization analysis, and membership trend reporting. +… more
- Molina Healthcare (Columbus, OH)
- …**Job Summary** Respond to inbound calls to provides support for provider claims adjudication activities including responding to providers to address claim issues, ... and researching, investigating and ensuring appropriate resolution of claims . **Knowledge/Skills/Abilities** + Responds to incoming calls from providers regarding … more
- Molina Healthcare (Akron, OH)
- JOB DESCRIPTION Job Summary Provides support for claims recovery activities including researching claim payment and billing guidelines, audit results, and federal ... to facilitate recovery of outstanding overpayments. Monitors and controls backlog and workflow of claims and ensures that claims are settled in a timely fashion… more
- Molina Healthcare (OH)
- …Job Summary Respond to inbound calls to provides support for provider claims adjudication activities including responding to providers to address claim issues, and ... researching, investigating and ensuring appropriate resolution of claims . **Essential Job Duties** * Responds to incoming calls from providers regarding claims … more
- Norstella (Columbus, OH)
- …(PharmD) or Medicine (MD/DO) degree. + Experience working with and querying large healthcare databases, including claims , EMR/EHR, and laboratory data, in an ... **The Role:** In this role, you will leverage your expertise in ** healthcare data analytics** to extract meaningful insights from **real-world data (RWD)** sources,… more
- Elevance Health (Cincinnati, OH)
- **Business Architect Sr. - Claims Systems** **Location:** This role requires associates to be in-office 1 day per week, fostering collaboration and connectivity, ... as required by law. The **Business Architect Sr. - Claims Systems** will be part of Elevance Health's National...dedicated to improving lives and communities - and making healthcare simpler. We are a Fortune 25 company with… more