- Prime Therapeutics (Columbus, OH)
- …analysis to include 3 years of experience in Pharmacy Benefit Management (PBM), claims processing , healthcare , and/or related field + Previous experience ... Recommend new and revised financial pricing programs based on analysis of pharmacy claims data, average wholesale drug prices (AWP), and other relevant data of… more
- Prime Therapeutics (Columbus, OH)
- …analysis to include 3 years of experience in Pharmacy Benefit Management (PBM), claims processing , healthcare , and/or related field. + Previous experience ... Recommend new and revised financial pricing programs based on analysis of pharmacy claims data, average wholesale drug prices (AWP), and other relevant data of… more
- Humana (Columbus, OH)
- …payor operations, technology, communications, and processes + Solid understanding of healthcare operations, particularly around claims processing , ... make an impact** **Required Qualifications** + Bachelor's degree in healthcare administration, public health, information systems, business, policy administration or… more
- Molina Healthcare (OH)
- …Lead Analyst, Configuration Oversight to support our Payment Integrity and Claims Operations teams in ensuring the accuracy and compliance of Coordination ... of Benefits (COB) claim pricing and processing . This role will focus on identifying, reviewing, and...guidance. The ideal candidate will bring deep knowledge of claims adjudication, QNXT system navigation, and strong analytical acumen.… more
- Molina Healthcare (Cleveland, OH)
- …and test assumptions through data, but lead with contextual knowledge of claims processing , provider contracts, and operational realities. + Creates succinct ... trends, payment integrity issues, and process gaps. + Applies understanding of healthcare regulations, managed care claims workflows, and provider reimbursement… more
- Molina Healthcare (Cincinnati, OH)
- …concisely and accurately, in accordance with regulatory requirements. + Research claims processing guidelines, provider contracts, fee schedules and system ... + Min. 3 years operational managed care experience (call center, appeals or claims environment). + Health claims processing background, including… more
- Molina Healthcare (Columbus, OH)
- …concisely and accurately, in accordance with regulatory requirements. + Research claims processing guidelines, provider contracts, fee schedules and system ... + Min. 2 years operational managed care experience (call center, appeals or claims environment). + Health claims processing background, including… more
- Molina Healthcare (OH)
- …Provides leadership and direction to MMS Operational Units management staff (eg, Claims Processing , Provider Services, Provider Enrollment, Finance, Managed Care ... or equivalent experience **Required Experience** 3 years supervision/management experience in Claims Processing or Provider Services environment and/or any high… more
- Molina Healthcare (Cincinnati, OH)
- …and tests assumptions through data, but leads with contextual knowledge of claims processing , provider contracts, and operational realities. + Creates succinct ... trends, payment integrity issues, and process gaps. + Applies understanding of healthcare regulations, managed care claims workflows, and provider reimbursement… more
- Molina Healthcare (Akron, OH)
- …and test assumptions through data, but lead with contextual knowledge of claims processing , provider contracts, and operational realities. + Create succinct ... trends, payment integrity issues, and process gaps. + Apply understanding of healthcare regulations, managed care claims workflows, and provider reimbursement… more