- Molina Healthcare (Cincinnati, OH)
- …information on all claims and provider databases. Synchronizes data among multiple claims systems and application of business rules as they apply to each ... for this position, please apply through the intranet job listing. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare … 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 ... + 3-5 years' experience in a combination of applicable business and business systems + Computer Science or Info tech + Testing experience required + Data… more
- Prime Therapeutics (Columbus, OH)
- …and Medicaid Services rules and regulations + 1 year of experience working with claims systems Every employee must understand, comply with and attest to the ... - JUDI Ops Team - Remote **Job Description** The Claims Technical Analyst is responsible for serving...years of work experience in data analysis, in the healthcare , insurance, finance or related industry + Must be… more
- Elevance Health (Mason, OH)
- …Information Analyst Senior** is responsible for analyzing and validating healthcare encounter data submissions to CMS (Centers for Medicare & Medicaid Services). ... strongly preferred. + Knowledge of SAS. + Knowledge of systems capabilities and Healthcare business operations. +...EDI experience. + Intermediate Microsoft Excel experience. + Facets systems knowledge considered a plus. + Claims … more
- Elevance Health (Mason, OH)
- **Data Scientist Analyst ** **Location:** This role requires associates to be in-office 1 - 2 days per week, fostering collaboration and connectivity, while providing ... unless an accommodation is granted as required by law. As a **Data Scientist Analyst ** , you will support the development of innovative analytics and AI solutions… more
- Evolent (Columbus, OH)
- …Codes, CPT Codes, RVUs, bundled payments, etc. + Working knowledge of healthcare claims ; specifically, differences between institutional vs professional billing ... health, biology) + 1+ years of professional experience in claims -based healthcare analytics with a payer, provider,...and utilization management is preferred + Understanding of data systems and the critical thinking skills to solve new… more
- Highmark Health (Columbus, OH)
- …scope and complexity + 5 years with coding languages, analytical software, systems , tools and processes using claims , clinical, enrollment and provider ... 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… 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 (Columbus, OH)
- …or team leadership experience + 10 years' work experience preferable in claims processing environment and/or healthcare environment + Strong knowledge of ... strategic analysis. **KNOWLEDGE/SKILLS/ABILITIES** Manages and provides direct oversight of Healthcare Analytics Team activities and personnel. Provides technical expertise,… 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