- Molina Healthcare (Cincinnati, OH)
- …coordination, and shared ownership of high-value deliverables-distinct from a pure data analyst role. **Job Duties** **Business Leadership & Operational Ownership** ... Assists and executes tasks and projects to ensure Centers for Medicare & Medicaid Services (CMS) and State regulatory requirements are met for Pre-pay Edits,… more
- Elevance Health (Columbus, OH)
- …and track the key performance metrics for assigned providers, ensuring data -driven decision-making. + **Documentation and Reporting :** Accurately document all ... join our team and drive the achievement of value-based care in the Medicare, Medicaid , and Commercial lines of business. The ideal candidate will be responsible for… more
- Molina Healthcare (Cincinnati, OH)
- …according to the SIU's standards. Position must have thorough knowledge of Medicaid /Medicare/Marketplace health coverage audit policies and be able to apply them in ... abuse, and over utilization by providers and recipients. The position will review claims data , medical records, and billing data from all types of healthcare… more
- Humana (Columbus, OH)
- …ranging from moderate to substantial. The Actuary, Analytics/Forecasting supports centralized reporting of external data sharing, oversees internal reporting ... The Actuary, Analytics/Forecasting analyzes and forecasts financial, economic, and other data to provide accurate and timely information for strategic and… more
- Molina Healthcare (OH)
- …experience in Medicare and in Medicaid managed care + Experience with data reporting , analysis, and/or interpretation + Certified Professional in Health ... intervention initiatives including all lines of business (Medicare, Marketplace, Medicaid ). Executes health plan's member and community quality focused interventions… more
- Trinity Health (Grove City, OH)
- …coinsurance and deposits. Gathers and evaluates confidential patient financial data for purposes of determining patient qualification for financial assistance ... ICD-9 coding to ensure compliance with third party regulations. Understands Medicare, Medicaid and other third party information requirements and adheres to all… more
- Elevance Health (Mason, OH)
- …presents financial results. + Manages prioritization and development of reports for business reporting and analysis purposes including ad hoc data analysis and ... plan financial analysis, cost of care analytics, trend analysis, financial reporting , financial operations, and cost and budget management and allocation.… more
- Trinity Health (Columbus, OH)
- …coverage. We rely on talented colleagues in a wide variety of professional roles including information technology, financial analysis, audit, provider relations and ... ensure accurate membership processing, application and reconciliation of all data and payments from CMS as well as accurate...monitors the special status tracking process to ensure accurate reporting and payment from CMS for enrollees who fall… more
- Humana (Columbus, OH)
- …Associate Actuary, Analytics/Forecasting analyzes and forecasts financial, economic, and other data to provide accurate and timely information for strategic and ... operational decisions. Establishes metrics, provides data analyses, and works directly to support business intelligence. Evaluates industry, economic, financial, and… more
- Humana (Columbus, OH)
- …The Actuary, Analytics/Forecasting analyzes and forecasts financial, economic, and other data to provide accurate and timely information for strategic and ... operational decisions. Establishes metrics, provides data analyses, and works directly to support business intelligence. Evaluates industry, economic, financial, and… more