- Highmark Health (Columbus, OH)
- …BE A US CITIZEN This position serves as a key liaison between Claims Operations, Customer Service, Regulatory Affairs, IT, Legal and other departments, proactively ... identifying, assessing, and mitigating compliance risks. The Analyst will monitor regulatory changes, interpret their impact on operational processes, and implement… more
- Evolent (Columbus, OH)
- …mission. Stay for the culture. **What You'll Be Doing:** Job Description ** Analyst , Integration Quality** Integration testing in the healthcare ecosystem ... exercised to ensure source to target integrity. The IQ Analyst (IQA) performs analysis, reporting, and technical testing across...work experience + General knowledge of data flow and healthcare end to end system landscape + Good knowledge… more
- Evolent (Columbus, OH)
- …analyses into succinct presentations. + Perform research and analysis of complex healthcare claims , eligibility, and pharmacy data to make recommendations based ... RVUs, bundled payments, etc. is preferred + Working knowledge of healthcare claims ; specifically, differences between institutional vs professional billing… more
- Medical Mutual of Ohio (OH)
- …report performance on key quality indicators, including but not limited to Healthcare Effectiveness Data and Information Set (HEDIS), STARS, Consumer Assessment of ... Healthcare Providers and Systems (CAHPS) and Healthcare ...documentation and builds updated requirements for annual HEDIS Specification application and coordinates implementation. . Supports HEDIS submission lifecycle… more
- Elevance Health (Mason, OH)
- **Business Information Analyst Senior - Provider Economics** **Location:** This role requires associates to be in-office 1 day per week, fostering collaboration and ... an accommodation is granted as required by law. The **Business Information Analyst Senior** is responsible for analyzing, reporting and developing recommendations on… more
- Humana (Columbus, OH)
- …and help us put health first** The Medicaid (PPS) Provider Hospital Reimbursement Analyst also known as a Senior Business Intelligence Engineer will be an integral ... IT, the pricing software vendor, CIS BSS, Medicaid operations, claims operations, and other business teams involved in the...benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also… more
- 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 Customer Reporting group as a Senior Reporting Analyst within our Compliance Pharmacy Payments. CVS Health strives...a collaborative, close-knit team on pharmacy and member specific claims data including, but not limited to, financial and… 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)
- …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
- Cleveland Clinic (Cleveland, OH)
- …+ Experience with implementing and supporting major systems in a clinical or system analyst capacity + Experience in application of project management and system ... be responsible for overseeing all aspects of system planning, application development, and support in alignment with the strategic...for the ideal future caregiver include: + Knowledge of healthcare operations + Claims experience - waystar,… more