- CVS Health (Raleigh, NC)
- …Trifacta, Linux OS, GCP/ AWS/ Azure. + Experience working with medical and/or pharmacy claims data. + Experience in healthcare industry, including health ... to join our PBM Customer Reporting group as a Senior Reporting Analyst within our Compliance Pharmacy ...You will work with a collaborative, close-knit team on pharmacy and member specific claims data including,… more
- Elevance Health (Winston Salem, NC)
- …referral, and use of proprietary data and claim systems for review of facility, professional and pharmacy claims . + Responsible for independently identifying ... **Investigator Senior ** **Supports the Payment Integrity line of business**...to recover corporate and client funds paid on fraudulent claims . Health insurance experience required with understanding of health… more
- Option Care Health (Charlotte, NC)
- …the best and brightest talent in healthcare. **Job Description Summary:** The Senior Director, Operations is responsible for delivering safe, efficient and effective ... while providing direct oversight for all operations in multiple branches including pharmacy dispensing and nursing. Scope requirements: 3 sites / 2 sites with… more
- Humana (Raleigh, NC)
- …with business partners to uphold ethical standards and mitigate risks. The Senior Clinical Compliance Professional will support the Director of Compliance, ... or data requires an in-depth evaluation of variable factors. As the Senior Clinical Compliance Professional , you will develop and/or evaluate compliance… more
- Genesis Healthcare (Pembroke, NC)
- …to improving health outcomes among residents of skilled nursing and senior living facilities. Our physicians, nurse practitioners (NPs) and physician assistants ... Help articulate the AlignMed Partners mission to the community and professional organizations Help the center establish appropriate relationships, and coordinate… more
- Prime Therapeutics (Raleigh, NC)
- …internal stakeholders to research and resolve regulatory inquiries/complaints related to claims , contracting and pharmacy reimbursement. Works directly with ... Analyst - Remote **Job Description** The Regulatory Inquiry & Complaints Senior Compliance Analyst assists in the implementation of Prime's compliance programs,… more
- CenterWell (Raleigh, NC)
- …team at the branch to ensure other billing requirements are satisfied to release claims timely. . Adhere to and participate in Agency's mandatory HIPAA / Privacy ... Guidelines. . Managing all incoming telephone calls in a professional manner including: o Screen and route calls to...at the center. As the nation's largest provider of senior -focused primary care, one of the largest providers of… more