- Molina Healthcare (Dallas, TX)
- …for accurate and timely implementation and oversight of critical information on claims databases. Synchronizes data among operational and claims systems and ... experience and knowledge to research and resolve claim/encounter issues, pended claims and facilitate system update(s) as necessary. + Works with fluctuating… more
- Norstella (Topeka, KS)
- …(PharmD) or Medicine (MD/DO) degree. + Experience working with and querying large healthcare databases, including claims , EMR/EHR, and laboratory data, in an ... **The Role:** In this role, you will leverage your expertise in ** healthcare data analytics** to extract meaningful insights from **real-world data (RWD)** sources,… more
- MVP Health Care (Rochester, NY)
- … healthcare quality data highly preferred + Subject matter expertise in healthcare data- claims , coding, HIE's etc. Experience with quality metrics, (NCQA ... opportunity for you if you have a passion for healthcare , innovation, and collaboration. **What's in it for you:**...that may arise, reflecting our collective goal of enhancing healthcare delivery and being the difference for the customer.… more
- Cognizant (Chicago, IL)
- …influence senior leadership. **These will help you stand out** + Domain expertise in Healthcare Claims . + Knowledge of Machine Learning (ML) and advanced AI ... concepts. + Experience in building and enhancing test automation frameworks, service virtualization, and CI/CD pipeline configuration. + Ability to create innovative automation strategies and frameworks that deliver measurable business value. We're excited to… more
- COOLSOFT (Columbia, SC)
- …IN A STRESSFUL ENVIRONMENT PREFERRED SKILLS (RANK IN ORDER OF IMPORTANCE): HEALTHCARE CLAIMS PROCESSING PROCESS DEVELOPMENT AND MANAGEMENT INCIDENT AND CHANGE ... MANAGEMENT REQUIRED EDUCATION AND EXPERIENCE: A bachelors degree and 6-12 years of project management experience. REQUIRED CERTIFICATIONS: Project Management Professional (PMP) Call502-379-4456 Ext 100for more details. Please provide Requirement id: 156217… more
- CVS Health (Blue Bell, PA)
- …+ 5+ years of experience with SAS programming + 3+ years' experience with healthcare claims data analysis + 3+ years' experience with extract-transform-load data ... files + Experience in preparation and data management plan/ documentation + Experience working with and integrating large datasets from multiple sources + Experience with the FDA on research initiatives and data driven projects + Proficient with multi-tasking… more
- BlueCross BlueShield of Tennessee (Chattanooga, TN)
- …quality care, and driving excellence in one of the most impactful areas of healthcare \. For seasoned claims professionals, this is more than a job; it's ... of our compliance champions\! With your strong background in claims processing, you'll play a pivotal role in monitoring...role in monitoring Medicare Advantage Part C and D claims to ensure accuracy, integrity, and compliance across the… more
- HCA Healthcare (Asheville, NC)
- …in clinical risk management preferred. A broad-based working knowledge of healthcare delivery systems, risk management, claims administration and clinical ... Office to promote growth and unlock possibilities. At HCA Healthcare , we are committed to the care and improvement...+ Employee Stock Purchase Plan with 10% off HCA Healthcare stock + Family support through fertility and family… more
- Cedars-Sinai (CA)
- **Job Description** The Claims Examiner is responsible for accurately and consistently adjudicating claims in accordance with policies, procedures and guidelines ... as outlined by the company policy. Process claims according to all CMS and DMHC guidelines. Investigate and complete open or pended claims . Meet production and… more
- Somatus (Mclean, VA)
- …patient safety, NCQA HEDIS quality performance, etc. + Analyze, interpret and apply healthcare payor claims data around $PMPM, Unit/1000, $$/Unit metrics to ... grow, and be the best version of themselves, including: + Subsidized, personal healthcare coverage (medical, dental vision) + Flexible Paid Time Off (PTO) +… more