- Evolent (Columbus, OH)
- …**What You Will Be Doing:** + **Data Analytics & Insights** : Analyze healthcare claims and authorization data to identify cost drivers, utilization trends, ... working seamlessly with diverse teams and stakeholders. + Familiarity with healthcare claims , reimbursement methodologies, and cost/utilization KPIs, including… more
- Molina Healthcare (Cincinnati, OH)
- …proficiency in SQL for large dataset analysis and transformation, specifically in processing healthcare claims data and supporting managed care reporting needs + ... solutions. * Write advanced SQL queries to extract, validate, and analyze healthcare data, including claims , authorization, pharmacy, and lab datasets. *… more
- CVS Health (OH)
- …Experience in healthcare fraud, waste and abuse + Knowledge of Medicaid healthcare claims adjudication (QNXT) & regulatory reporting + Experience with data ... skills in SQL and Python who can transform complex healthcare data into actionable insights to support fraud, waste,...investigations of potential fraud, waste, and abuse in Medicaid claims and provider activity. + Prepare timely and accurate… more
- Baylor Scott & White Health (Columbus, OH)
- … Claims , MMR, MOR, MAO-002, MAO-004 and RAPs/EDS data + Experience with Healthcare claims , enrollment and pharmacy data is preferred + Knowledge of ACA, ... and outbound encounter process. + Monitors and oversees the end-to-end claims encounter management workflow. + Identifies and interprets encounter data, submission… more
- Molina Healthcare (Akron, OH)
- …EXPERIENCE:** 3+ years of experience in claims as Adjuster or claims examiner in the healthcare field **PHYSICAL DEMANDS:** Working environment is ... accurate and timely implementation and maintenance of critical information on all claims and provider databases, validate data housed on databases and ensure… more
- Molina Healthcare (Dayton, OH)
- …trends, payment integrity issues, and process gaps. + Applies understanding of healthcare regulations, managed care claims workflows, and provider reimbursement ... and executing operational initiatives tied to Payment Integrity (PI) and provider claims accuracy. The individual will be relied upon to make independent, informed… more
- Humana (Columbus, OH)
- … claims analytics dataset using Databricks. Conduct in-depth analysis of healthcare claims utilizing revenue codes, CPT/HCPCS, ICD-10 diagnosis codes, DRG, ... claim datasets and conducting trend analysis + Deep understanding of healthcare claims taxonomy (service categories, such as LTSS) + Advanced knowledge of… more
- Evolent (Columbus, OH)
- …Codes, CPT Codes, RVUs, bundled payments, etc. + Working knowledge of healthcare claims ; specifically, differences between institutional vs professional billing ... public health, biology) + 1+ years of professional experience in claims -based healthcare analytics with a payer, provider, clinical vendor, managed care, or… more
- ICF (Columbus, OH)
- …Skills/Experience:** + Advanced degree in a related field. + Demonstrated knowledge of healthcare claims data, including Medicare and Medicaid. + Experience with ... and investigation. This role requires a deep understanding of healthcare data systems, Medicare and Medicaid claims ,...of healthcare data systems, Medicare and Medicaid claims , and the government's healthcare fraud, waste,… more
- Evolent (Columbus, OH)
- …or related healthcare consulting entity + Extensive knowledge of healthcare claims ; specifically, differences between institutional vs professional billing ... public health, biology) + At least 5 years of professional experience in claims -based healthcare analytics with a payer, provider, vendor, managed care,… more
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