- Zelis (St. Petersburg, FL)
- …Claim Review. They will be responsible for reviewing facility inpatient and outpatient claims for Health Plans and TPA's to ensure adherence to proper coding and ... to the Itemized Bill Review product, analyzing inpatient DRG claims based on industry standard inpatient coding guidelines, and...expert for content and bill review s and provide support where needed for inquiries and research requests. +… more
- Actalent (Montville, NJ)
- …least 1 year of retail experience preferred. + Proficiency in order entry, claims , filling, labeling, insurance, and healthcare support . Additional Skills & ... Qualifications + PharmD preferred. + Ability to handle stress and adapt to various situations. + Comfortable working independently or within a team. + Maturity, professionalism, and the ability to work with diverse personalities. + Strong technical ability and… more
- CGI Technologies and Solutions, Inc. (Canton, MA)
- …Rule, TEFCA-related requirements) and translate them into actionable system requirements. . Support gap analysis for existing payer systems ( claims , clinical ... . Ensure solutions integrate effectively with enterprise systems such as claims adjudication, enrollment, provider management, UM/PA, care management, and data… more
- US Tech Solutions (Columbia, SC)
- …provides health management program interventions. Utilizes clinical proficiency and claims knowledge/analysis to assess, plan, implement, health coach, coordinate, ... medical necessity and/or care plan compliance, options, and services required to support members in managing their health, chronic illness, or acute illness.… more
- IQVIA (Durham, NC)
- …The Principal Biostatistician is responsible for providing full range statistical support for drug development based on real world evidence (RWE). **Additional ... + Writes statistical analysis plans. + Provides strategic and tactical support for cross-functional RWE development for regulators, payers, and clinicians. +… more
- AON (Los Angeles, CA)
- …including technical writing and verbal presentation skills. + Establish understanding of claims administration process and utilize the claims and legal advocacy ... programs, and/or leading collaboration across offices and/or geographies to support multinational risk management/finance practices on behalf of insureds, brokers,… more
- Army National Guard Units (North Las Vegas, NV)
- …of the position. You must provide transcripts or other documentation to support your Training/Educational claims . To receive credit for Training/Education, you ... must provide documentation of proof that you meet the Training/Education requirements for this position. Additional Information - If you are a male applicant who was born after 12/31/1959 and are required to register under the Military Selective Service Act,… more
- Otsuka America Pharmaceutical Inc. (GA)
- …and education. The Field Clinical Specialist also provides procedure support including case proctoring, physician certifications, and site qualification visits. ... **Responsibilities and Duties:** **Drive Provider Referral Program:** + Analyze claims and EMR data to identify high-potential providers and patient populations. +… more
- HCA Healthcare (Denver, CO)
- …Employee Stock Purchase Plan with 10% off HCA Healthcare stock + Family support through fertility and family building benefits with Progyny and adoption assistance. ... banking partnerships + Education assistance (tuition, student loan, certification support , dependent scholarships) + Colleague recognition program + Time Away… more
- Humana (Columbus, OH)
- …community and help us put health first** Own and manage Medicaid claims analytics dataset using Databricks. Ensure data accuracy, completeness, and readiness to ... support modeling, reporting, and decision-making. Requires strong project management...transformations, automation, and enhancements. Conduct in-depth analysis of healthcare claims to identify data issues and optimization opportunities. Work… more