- CommonSpirit Health (Englewood, CO)
- …proven track record of success in managing complex data environments and experience with healthcare claims and utilization datasets. If you are a motivated and ... user engagement through post-implementation evaluation **Preferred Experience** + Working knowledge of healthcare claims and remit data + Working knowledge of… more
- Dallas Behavioral Healthcare Hospital (Desoto, TX)
- …research, and correspond with insurance companies to obtain accurate reimbursement for healthcare claims . This person will also be responsible for analyzing, ... and healthcare professionals to resolve issues resulting from denied claims + Adhere to coding policies and procedures consistent with the industry-standard… more
- Molina Healthcare (Kenosha, WI)
- …and appeals experience. **Required Experience** * 7 years experience in healthcare claims review and/or member appeals and grievance processing/resolution, ... 2 years in a manager role. * Experience reviewing all types of medical claims (eg HCFA 1500, Outpatient/Inpatient UB92, Universal Claims , Stop Loss, Surgery,… more
- Evolent (Helena, MT)
- …**What You Will Be Doing:** + **Data Analytics & Insights** : Analyze healthcare claims and authorization data to identify cost drivers, utilization trends, ... working seamlessly with diverse teams and stakeholders. + Familiarity with healthcare claims , reimbursement methodologies, and cost/utilization KPIs, including… more
- Molina Healthcare (Phoenix, AZ)
- …proficiency in SQL for large dataset analysis and transformation, specifically in processing healthcare claims data and supporting managed care reporting needs + ... solutions. * Write advanced SQL queries to extract, validate, and analyze healthcare data, including claims , authorization, pharmacy, and lab datasets. *… more
- CVS Health (FL)
- …Experience in healthcare fraud, waste and abuse + Knowledge of Medicaid healthcare claims adjudication (QNXT) & regulatory reporting + Experience with data ... skills in SQL and Python who can transform complex healthcare data into actionable insights to support fraud, waste,...investigations of potential fraud, waste, and abuse in Medicaid claims and provider activity. + Prepare timely and accurate… more
- Molina Healthcare (GA)
- …solutions + Advanced knowledge of health care benefits. + Advanced knowledge of healthcare claims and claim processing from receipt through encounter submission. ... including accurate and timely implementation and maintenance of critical information on claims databases. Validate data to be housed on databases and ensure… more
- Molina Healthcare (New York, NY)
- …health, more affordably. Performs research, financial modeling, and analysis of complex healthcare claims data (medical, pharmacy and ancillary) to deliver ... through contract valuation and analysis to ensure access to quality healthcare services for people receiving government assistance. Strengthens access to quality… more
- CVS Health (Franklin, TN)
- …of problem solving and decision making skills **Preferred Qualifications** + 1-2 years healthcare claims processing experience preferred + claims processing ... communication skills. **Job Description Summary** + Handles and processes Benefits claims submitted by healthcare providers, ensuring accuracy, efficiency, and… more
- AdventHealth (Maitland, FL)
- …shared savings, bundled payments, pay-for-performance, and capitation Working knowledge of healthcare claims for all provider types Managed Care, Patient ... using knowledge of healthcare managed care contracts and healthcare administrative claims data Reviews existing complex models and implements them on new… more