- CVS Health (Columbus, OH)
- …Linux OS, GCP/ AWS/ Azure * Experience working with medical and/or pharmacy claims data * Experience in healthcare industry, including health insurance, PBM ... our PBM Finance Enablement group as a Senior Reporting Analyst within our PBM Customer Reporting team. CVS Health...a collaborative, close-knit team on pharmacy and member specific claims data including, but not limited to, financial and… more
- CVS Health (Columbus, OH)
- …every day. **Position Summary** We are seeking an experienced Senior Healthcare Fraud Investigator to join our Dental/Pharmacy/Broker Investigative Team within ... role, you will manage complex investigations into suspected and known acts of healthcare fraud, waste and abuse (FWA). **Key Responsibilities** + Conduct high level,… more
- Highmark Health (Columbus, OH)
- …and/or create analytics and reporting solutions aligned to the Quadruple Aim of Healthcare : lower per capita health care costs, improved outcomes from and quality of ... to identify, develop and/or monitor actionable opportunities for improving health and healthcare outcomes and clinical quality and costs of care, efficiently and… more
- CVS Health (Columbus, OH)
- …setup, essential for online viewing and processing, related to customer service, claims , enrollment, billing, and reporting, in support of internal and external ... level benefits to align with industry coding (ICD 10, place of service, healthcare reform, etc.), similar to entry-level IT programming. + Solicits and assesses… more
- CVS Health (Columbus, OH)
- …conducts investigations to effectively pursue the prevention, investigation and prosecution of healthcare fraud and abuse, to recover lost funds, and to comply with ... in a prepayment environment - Investigates to prevent payment of fraudulent claims committed by insured's, providers, claimants, etc. - Researches and prepares cases… more
- Molina Healthcare (Akron, OH)
- …trends, payment integrity issues, and process gaps. + Apply 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
- Molina Healthcare (OH)
- …or team leadership experience + 10 years' work experience preferable in claims processing environment and/or healthcare environment + Strong knowledge of ... staff for mentoring, coaching, and analysis questions. + Reviews Medical Economics analyst work products to ensure accuracy and clarity. + Reviews regulatory… more
- Elevance Health (Cincinnati, OH)
- …and identify impact on existing programs. + Conduct comprehensive analysis of healthcare data, claims , and financial reports to identify trends, patterns, ... consolidating processes for forecast and month-end results. + Serve as an analyst and advisory to both internal and external stakeholders, developing value-based… more
- Cleveland Clinic (Cleveland, OH)
- …Preferred qualifications for the ideal future caregiver include: + Knowledge of healthcare operations + Claims experience - waystar, experian, availity, other ... Clinic team, where you will work alongside passionate caregivers and provide patient-first healthcare . Cleveland Clinic is recognized as one of the top hospitals in… more