- Oracle (Columbus, OH)
- …and predictive analytics. * Apply generative AI to synthesize insights from multi-modal healthcare data (eg, EHRs, imaging, claims , and demographics) to enhance ... Oracle Health Data Intelligence (HDI) is leading the charge in transforming healthcare with innovative data and AI solutions. We're seeking a highly skilled… more
- Molina Healthcare (Akron, OH)
- JOB DESCRIPTION Job Summary Leads and manages team responsible for claims activities including reviewing and resolving member and provider complaints, and ... oversees necessary correspondence in accordance with regulatory requirements. * Ensures claims production standards set by the department are met. * Maintains… more
- Molina Healthcare (OH)
- …to ensure that internal and/or regulatory timelines are met. + Research claims appeals and grievances using support systems to determine appeal and grievance ... assures timeliness and appropriateness of responses per state, federal and Molina Healthcare guidelines. + Responsible for meeting production standards set by the… more
- Molina Healthcare (OH)
- …Responsible for accurate and timely auditing of critical information on claims databases. Maintains critical auditing and outcome information. Synchronizes data ... among operational and claims systems and application of business rules as they...position, please apply through the intranet job listing. Molina Healthcare offers a competitive benefits and compensation package. Molina… more
- Molina Healthcare (Cleveland, OH)
- …accurate and timely implementation and maintenance of critical information on claims databases. Maintains critical information on claims databases. Synchronizes ... Hospital payment methodology & processing is essential + Understanding on hospital claims processing and configuration works + Medicare fee schedule knowledge is… more
- Molina Healthcare (Cincinnati, OH)
- … healthcare operations (utilization management, disease management, HEDIS quality measures, claims processing, etc.) + Knowledge of healthcare financial terms ... related to cost, utilization and revenue for multiple Molina Healthcare products. Analyzes data and dashboard reports to monitor...and manage information from large data sources. + Analyze claims and other data sources to identify early signs… more
- Humana (Columbus, OH)
- …+ 2 or more years of project leadership experience + Strong experience with healthcare data, particularly clinical and claims data used in **HEDIS measurement** ... bridges product ownership, data and software engineering, and regulatory healthcare data requirements, ensuring that data ingestion, transformation, and delivery… more
- Molina Healthcare (OH)
- …SIU Coding Investigator is responsible for investigating and resolving instances of healthcare fraud and abuse by medical providers. This position uses information ... enforcement or for payment recovery. **KNOWLEDGE/SKILLS/ABILITIES** + Reviews post pay claims with corresponding medical records to determine accuracy of claims… more
- Humana (Columbus, OH)
- …a related field, or equivalent work experience. + Demonstrated experience in claims analysis, payment integrity, or healthcare data analytics, preferably within ... anomalies in data to identify and collect overpayment of claims . Contributes to the investigations of fraud waste and...benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also… 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 ... the development, implementation and maintenance of provider data in the claims payment system. * Supports critical business strategies by providing systematic… more