- Molina Healthcare (Akron, 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 (Columbus, OH)
- …operations (utilization management, disease management, HEDIS quality measures, claims processing , etc.) + Knowledge of healthcare financial terms (eg, PMPM, ... 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
- Molina Healthcare (Columbus, OH)
- …Provider Network Operations, Hospital or Physician Billing, or similar. + Claims processing background including coordination of benefits, subrogation, and/or ... and timely validation and maintenance of critical provider information on all claims and provider databases. Staff ensure adherence to business and system… more
- Molina Healthcare (Cincinnati, OH)
- …of encounters as well as provides leadership support at managing overall healthcare costs. + Ability to influence across multiple organizational functions - Payment ... Integrity, Claims , Encounters, Finance, and Actuarial + Proven experience in...staff and implements processes to standardize the overall ends-to-end processing , management and accuracy of encounters, as well as… more
- Molina Healthcare (OH)
- …in Medicaid, Medicare, and Marketplace lines of business. + Familiarity with QNXT claims processing platform. + Knowledge of legal procedures related to complex ... The Subrogation Manager is responsible for overseeing all aspects of healthcare subrogation operations across Medicaid, Medicare, and Marketplace lines of business.… more
- Molina Healthcare (Columbus, OH)
- …equivalent discipline **Required Experience** + 3-5 Years of experience with healthcare -related data ( claims /encounters, provider, CMS/EDGE response files, etc. ... of programming experience in python to support automated data validation / processing at scale (functions and objects) **PHYSICAL DEMANDS** Working environment is… more
- Molina Healthcare (Cincinnati, OH)
- …conducts research to resolve customer initiated issues related to core systems processing , and coordinates and manages project teams in the development of large ... + SQL expertise + Excel expertise + Medicare, Medicaid, Marketplace claims expertise **PHYSICAL DEMANDS:** Working environment is generally favorable and lighting… more
- Molina Healthcare (OH)
- **Job Description** **Job Summary** Responsible for preparation, processing and maintenance of new members and re-enrollment. Processes and maintains health plan's ... rejections. Address a variety of enrollment questions or concerns received via claims , call tracking, or e-mail. Maintain records in the enrollment database.… more
- Molina Healthcare (Columbus, OH)
- **Job Description** **Job Summary** Responsible for preparation, processing and maintenance of new members and re-enrollment. Processes and maintains health plan's ... rejections. Address a variety of enrollment questions or concerns received via claims , call tracking, or e-mail. Maintain records in the enrollment database.… more
- Elevance Health (Mason, OH)
- …+ Requires a HS diploma or equivalent and minimum of 4 years claims processing and/or customer service experience; or any combination of education ... higher level degree preferred. + Leadership experience in a claims processing environment preferred Please be advised...dedicated to improving lives and communities - and making healthcare simpler. We are a Fortune 25 company with… more