- Humana (Montpelier, VT)
- …JD, MSN, Clinical Certifications, CPC, CCS, CFE, AHFI) + Understanding of healthcare industry, claims processing and internal investigative process development + ... Bachelor's Degree + Minimum of 3 yrs health insurance claims or Medicare experience + Minimum 3 years of...benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also… more
- CVS Health (CT)
- …coding. - Advanced skills with Microsoft Excel - Experience in healthcare /medical insurance claims investigation or professional/clinical experience - Background ... to effectively pursue the prevention, detection, investigation and prosecution of healthcare fraud, waste, and abuse. Also reports suspected fraud, waste, and… more
- Geisinger (Danville, PA)
- Job Summary We are seeking a detail-oriented professional with strong healthcare billing and claims experience to join our team. The successful candidate will be ... coding and proper setup of payment terms within the claims processing module. This role also involves contributing to...patients and members and the Geisinger family We offer healthcare benefits for full time and part time positions… more
- Evolent (Carson City, NV)
- …seamlessly with diverse teams and stakeholders. + Deep understanding of healthcare claims , reimbursement methodologies, and cost/utilization KPIs, including ... preferred. + 10+ years of analytics & reporting experience in healthcare , including medical economics, cost/utilization analysis, and membership trend reporting. +… more
- Somatus (Mclean, VA)
- …Engineer to create impact among Somatus' clients and leadership by analyzing Somatus' healthcare claims and care management data. This position will work ... grow, and be the best version of themselves, including: + Subsidized, personal healthcare coverage (medical, dental vision) + Flexible Paid Time Off (PTO) +… more
- Emory Healthcare/Emory University (Atlanta, GA)
- …annual operating plan for the Emory Health Plan. + Translates trends in claims , utilization, and healthcare market shifts into actionable strategies that support ... or integrated health systems. + Deep knowledge of health plan operations, claims analysis, actuarial principles and healthcare finance. + Demonstrated ability… more
- Centene Corporation (Rocky Mount, NC)
- …scheduler ideally Active Batch.. Knowledge in the different areas of Healthcare (credentialing, claims , authorizations, telephonics, quality) Pay Range: ... for business operations in all or some of the following areas: claims , provider data, member data, clinical data, vision/dental or medical, external reporting.… more
- CVS Health (Scottsdale, AZ)
- …VB.NET, MVC, Angular, SQL, Entity Framework + Strong domain knowledge in healthcare systems ( claims processing, member/provider data, EDI 837 submissions). + ... for a highly skilled Senior Developer with a strong background in healthcare systems and hands-on experience in software development. The ideal candidate will… more
- Highmark Health (Honolulu, HI)
- …You will proactively identify opportunities to construct and leverage comprehensive healthcare knowledge graphs, integrating diverse patient, provider, claims , ... from concept to prototype. + ** Healthcare Data Familiarity:** Understanding of healthcare data domains ( claims , clinical, EMR) and related ontologies or… more
- Molina Healthcare (Cleveland, OH)
- **Job Description** **Job Summary** The Provider Claims Adjudicator is responsible for responding to providers regarding issues with claims , coordinating, ... investigates and confirms the appropriate resolution of claims issues. This role will require actively researching issues to adjudicate claims Requires knowledge… more