- CVS Health (Columbus, OH)
- …promote effective utilization of healthcare services. This position promotes/supports quality effectiveness of healthcare services. This is a predominately remote, ... accurate and complete documentation of required information that meets risk management, regulatory, and accreditation requirements. + Protects the confidentiality… more
- Molina Healthcare (Akron, OH)
- …Molina policies/procedures or CMS guidelines/regulations, or to assess the non-clinical quality of customer service provided to Molina members. * Provides ... discuss and resolve issues related to utilization management, pharmacy, quality of care, and correct coding. * Independently delivers...2 - 3 years customer service, provider service, or claims experience in a managed care setting. * Working… more
- Centene Corporation (Columbus, OH)
- …additional process and performance related initiatives to achieve continuous quality improvement in Buckeye Community Health Plan's and provider's performance. ... network spend. + Interprets and analyzes data from multiple sources including claims , provider, member, and encounters data. Identifies and assesses the business… more
- Molina Healthcare (Cincinnati, OH)
- …advanced SQL queries to extract, validate, and analyze healthcare data, including claims , authorization, pharmacy, and lab datasets. * Build and maintain efficient ... on utilization, outcomes, and cost drivers across the organization. * Ensure data quality , governance, and documentation standards are met in all analytics work. *… more
- Parker Hannifin Corporation (Cleveland, OH)
- …suppliers, and may assist with bid evaluations, cost analyses, price justification, and risk assessment of suppliers. + May assist with supplier negotiations on new ... agreements that may delay production or delivery. + Resolve shipment quality discrepancies by mediating supplier/manufacturing issues. + Facilitate the resolution of… more
- EFI Global (Columbus, OH)
- …and environmental services teams around the world share a dedication to expertise, quality and demonstrating to customers that caring counts(R). Each of our more ... **Collaborates with sales and operations managers, architects, developers, insurance adjusters, claims managers and attorneys to develop demand for your professional… more
- Highmark Health (Columbus, OH)
- …and retrospective coding audit activities. Reviews medical records to determine data quality and accuracy of coding, billing and documentation related to DRGs, APCs, ... areas. Uses information to generate topics for education, training, process changes, risk reduction, optimization of reimbursement with new and current coders in… more
- Molina Healthcare (Dayton, OH)
- …advanced SQL queries to extract, validate, and analyze healthcare data, including claims , pharmacy, and lab datasets. + Build and maintain efficient ETL pipelines ... on utilization, outcomes, and cost drivers across the organization. + Ensure data quality , governance, and documentation standards are met in all analytics work. +… more
- Capgemini (Cincinnati, OH)
- …Medicaid or Exchange program/ product build knowledge (Enrollment, Eligibility, Claims , Provider network, encounters etc) (Highly Recommended having exposure to ... an expedited fashion Partner with project team to monitor and manage schedule, risk , issues, actions, decisions and change requests Partner with project team to plan… more
- Bon Secours Mercy Health (North Ridgeville, OH)
- …+ Gets employees back to work quickly and safely + Helps complete worker's compensation claims + Reduces the risk of future issues + Take advantage of a ... Bon Secours Mercy Health, we are dedicated to continually improving health care quality , safety and cost effectiveness. Our hospitals, care sites and clinicians are… more