- IQVIA (Durham, NC)
- …of secondary data sources and experience with secondary data analysis, including electronic medical record and/or medical claims databases + **Specifically, ... execution of the RWE strategy + Construct cohorts using RWD sources (eg, claims , EHR) and evaluate key variables, including diagnosis and procedures codes, and plan… more
- TEKsystems (Raleigh, NC)
- …high inbound calls; previous inbound experience is required with familiarity with medical terminology a plus. Agents will be handling 60-100 inbound calls per ... staff available to support the patients who need assistance. Skills insurance claim , call center, insurance verification, health care, insurance, patient access, … more
- Veterans Affairs, Veterans Health Administration (Durham, NC)
- …third party, Tort cases, Office of Workers Compensation cases, Humanitarian, Ineligible Claims , Personal Violence Claims , Bills of Collections and Sharing ... Managers; three Clinical Managers (either RN's or PA's); and 12 Advanced Medical Support Assistants. Incumbent also provides indirect supervision and leadership to… more
- CVS Health (Raleigh, NC)
- …R, Alteryx, Trifacta, Linux OS, GCP/ AWS/ Azure * Experience working with medical and/or pharmacy claims data * Experience in healthcare industry, including ... work with a collaborative, close-knit team on pharmacy and member specific claims data including, but not limited to, financial and operational information… more
- Elevance Health (Durham, NC)
- …healthcare analytics, and/or financial services highly preferred. + Comprehensive understanding of medical claims data. + Intermediate to Advanced expertise with ... Analytics Analyst Senior) measures financial performance of core Carelon products leveraging claims , authorization, and membership data to tell a detailed story to… more
- Humana (Raleigh, NC)
- …to make an impact** **Required Qualifications** + Minimum 1 year of experience in medical claims payment and processing + Minimum 1 year of experience analyzing ... and researching medical claims + Proficient in Microsoft Office (Word, Excel, Access, PowerPoint) + Working knowledge of SQL **Demonstrated understanding of… more
- Elevance Health (Durham, NC)
- …fraud and abuse prevention and control. + Review and conducts analysis of claims and medical records prior to payment. Researches new healthcare-related ... Payment Integrity, is determined to recover, eliminate and prevent unnecessary medical -expense spending. The **Clinical Fraud Investigator II** is responsible for… more
- TEKsystems (Morrisville, NC)
- …coordination, insurance billing, Health care, Data entry, Insurance, Call center, Medical terminology, Patient registration, Claim , Case management Additional ... other programs/organizations is an advantage Knowledge and experience in medical and pharmacy benefits/insurance is a plus Must be...for this temporary role may include the following: * Medical , dental & vision * Critical Illness, Accident, and… more
- UNC Health Care (Hendersonville, NC)
- …software to validate information. * Performs daily and weekly account audits from claim edit WQs, entering ICD-10-CM, CPT or HCPCS codes as needed to complete ... MRE Optum, MS Office, etc.) to compile and validate medical information. Reviews updated Medicare, AHA coding clinics, CPT...* Must hold a current certification or registration in medical coding as issued by the American Health Information… more
- CVS Health (Winterville, NC)
- …labeling all prescriptions + Resolve third party rejections and complete any manual claim forms + Perform all prescription pick-up procedures, in adherence of CVS ... direct customer to pharmacist if necessary + Field any medical questions when appropriate + Communicate and interact with...care + When applicable, solicit information on a customer's medical history to give appropriate medical advice… more