- CVS Health (Austin, TX)
- …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
- Molina Healthcare (Fort Worth, TX)
- …health, more affordably. Performs research, financial modeling, and analysis of complex healthcare claims data (medical, pharmacy and ancillary) to deliver ... through contract valuation and analysis to ensure access to quality healthcare services for people receiving government assistance. Strengthens access to quality… more
- Molina Healthcare (Austin, TX)
- …health, more affordably. Performs research, financial modeling, and analysis of complex healthcare claims data (medical, pharmacy and ancillary) to deliver ... through contract valuation and analysis to ensure access to quality healthcare services for people receiving government assistance. Strengthens access to quality… more
- Molina Healthcare (Austin, TX)
- …Experience working on SQL, PowerBI, databricks. + Experience on ETL , healthcare specifically claims is highly preferred. **JOB QUALIFICATIONS** **Required ... for this position, please apply through the intranet job listing. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare … more
- Humana (Austin, TX)
- …implement data transformations, automation, and enhancements. Conduct in-depth analysis of healthcare claims to identify data issues and optimization ... that align with customer needs and objectives + Deep understanding of healthcare claims taxonomy (service categories, such as LTSS) **Additional information**… more
- Evolent (Austin, TX)
- …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
- Prime Therapeutics (Austin, TX)
- …5 years of relevant Healthcare experience including: analyzing and using healthcare claims data, clinical research study design, and/or epidemiology + ... is responsible for the synthesis of data findings in support of clinical claims and programs. **Responsibilities** + Synthesizes a wide variety of data and outputs… more
- NTT America, Inc. (Plano, TX)
- …Denials + Knowledge in handling authorization, COB, duplicate, pricing and corrected claims process + Knowledge of healthcare insurance policy concepts including ... forward-thinking organization, apply now. We are currently seeking a Claims Examiner to join our team in Plano, Texas...Developing and maintaining a solid working knowledge of the healthcare insurance industry and of all products, services and… more
- NTT America, Inc. (Plano, TX)
- …Denials + Knowledge in handling authorization, COB, duplicate, pricing and corrected claims process + Knowledge of healthcare insurance policy concepts including ... these roles you will** **be responsible for:** + Review and process insurance claims . + Validate Member, Provider and other Claim's information. + Determine accurate… more
- NTT America, Inc. (Plano, TX)
- …and Denials Knowledge in handling authorization, COB, duplicate, pricing and corrected claims process Knowledge of healthcare insurance policy concepts including ... these roles you will be responsible for: Review and process insurance claims . Validate Member, Provider and other Claim's information. Determine accurate payment… more