- Molina Healthcare (Buffalo, NY)
- …technical solutions. + Write advanced SQL queries to extract, validate, and analyze healthcare data, including claims , pharmacy, and lab datasets. + Build and ... and collaborate cross-functionally to drive data-informed decisions in clinical and business operations . + Maintain fluency in healthcare data types (eg, ICD/CPT… more
- Molina Healthcare (Syracuse, NY)
- …leadership and direction to MMS Operational Units management staff (eg, Claims Processing, Provider Services, Provider Enrollment, Finance, Managed Care Provider ... Network), for management and supervision of daily functional operations to insure compliance to contract requirements. **Knowledge/Skills/Abilities** * Oversees… more
- Molina Healthcare (NY)
- …Experience** + 0-2 years of experience in data analytics, business intelligence, or healthcare operations + Foundational proficiency in SQL and exposure to ... Python or another programming language + Basic familiarity with healthcare data types such as claims , encounters, or eligibility data + Comfortable working with… more
- KPH Healthcare Services, Inc. (Gouverneur, NY)
- …clients into the PBM adjudication platform. Works closely with the Benefit Operations Supervisor in ensuring the team's goals are met. Translates client benefit ... and adjust within the adjudication platform. **Job Summary:** Perform day-to-day operations supporting ProAct's adjudication platform and the Benefit Operations … more
- KPH Healthcare Services, Inc. (East Syracuse, NY)
- …policy, procedure, and programs. **Job Summary:** Reporting to the Director of Operations , the Manager of Compliance and Clinical Operations is responsible ... utilization review and management requirements. The Manager of Compliance and Clinical Operations will also have oversight of HealthDirect's clinical operations … more
- Humana (Albany, NY)
- … operations , technology, communications, and processes + Solid understanding of healthcare operations , particularly around claims processing, enrollment, ... care experience + 5 + years in Medicaid program implementation or healthcare operations , with demonstrated leadership of complex, multi-disciplinary projects +… more
- Molina Healthcare (Syracuse, NY)
- …highly experienced Lead Analyst, Configuration Oversight to support our Payment Integrity and Claims Operations teams in ensuring the accuracy and compliance of ... operations + Must have strong understanding of QNXT claims processes + Must be able to identify and...position, please apply through the intranet job listing. Molina Healthcare offers a competitive benefits and compensation package. Molina… more
- Humana (Albany, NY)
- … operations , technology, communications, and processes + Solid understanding of healthcare operations , particularly around claims processing, enrollment, ... meetings to discuss IT priorities, new requests, and collaborate with Market Operations and Compliance teams. Facilitate and communicate with state agencies on… more
- Molina Healthcare (Syracuse, NY)
- … operations (utilization management, disease management, HEDIS quality measures, claims processing, etc.) + Knowledge of healthcare financial terms (eg, ... 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
- Molina Healthcare (Yonkers, NY)
- … operations (utilization management, disease management, HEDIS quality measures, claims processing, etc.) + Knowledge of healthcare financial terms (eg, ... related to cost, utilization and revenue for multiple Molina Healthcare products. Designs and develops reports to monitor health...and manage information from large data sources. + Analyze claims and other data sources to identify early signs… more