- 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 (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)
- …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
- CVS Health (Columbus, OH)
- …3-5 years. + Strong analytical and investigative skills, with experience in healthcare fraud detection. + Proficiency in interpreting claims data, medical ... that may compromise the integrity of the organization's operations and claims processes. **Core Responsibilities** + **Investigative Leadership** : Conducts thorough… 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
- 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
- Molina Healthcare (Akron, OH)
- …including accurate and timely maintenance of critical provider information on all claims and provider databases. Synchronizes data within multiple claims systems ... Ensures that provider information is loaded accurately to ensure proper claims processing, outbound reporting and directory processes. **Required Qualifications** *… more
- Molina Healthcare (Columbus, OH)
- JOB DESCRIPTION Job Summary Provides entry level support for claims activities including reviewing and resolving member and provider complaints, and communicating ... information system and prepares documentation for further review. * Researches claims issues utilizing systems and other available resources. * Assures timeliness… more
- Molina Healthcare (Akron, OH)
- …likelihood of a formal appeal being submitted. * Reevaluates medical claims and associated records independently by applying advanced clinical knowledge, knowledge ... specific programs supported by the plan such as utilization review, medical claims review, long-term services and supports (LTSS), or other specific program… more
- Molina Healthcare (Columbus, OH)
- …Supporting the OH Plan, the candidate will act as the Ohio Operation lead on Claims and Encounters as well as the liaison to our state regulator in these areas. ... developer role but the candidate must be technically inclined and interface with IT, Claims , and Encounter Teams. Must be a self-starter willing to learn. Must be a… more