- Stanford Health Care (Palo Alto, CA)
- …assignments, while identifying instances of overpayments and underpayments. Proficiency in healthcare claims analysis, including the ability to review, ... interpret, and evaluate claims data to identify trends, discrepancies, and opportunities for...completion. + Regulatory Compliance Stay updated on changes in healthcare regulations, payor policies, and industry best practices related… more
- CGI Technologies and Solutions, Inc. (Charlotte, NC)
- …roles, leading projects and teams . 5 years of experience in healthcare claims adjudication, medical coding, DRGs, and/or reimbursement methodologies . ... long-term relationships with key client stakeholders, including executive leadership, claims operations, finance, compliance, and clinical teams. * Lead client… more
- GovCIO (Salem, OR)
- …Skills and Experience** + Experience working with the Department of Veterans' Affairs + Healthcare Claims X.12 Transaction (837, 835, 277, etc.), Healthcare ... the testing strategy, planning, and execution across a portfolio of healthcare systems, ensuring compliance with regulatory standards and delivery of high-quality,… more
- Insight Global (King Of Prussia, PA)
- …https://insightglobal.com/workforce-privacy-policy/. Skills and Requirements - Prior experience working for Healthcare Insurance companies - Healthcare Claims ... Job Description Our client is a Healthcare Software company that provides revenue and payment...management and connects payers, providers, and patients to the healthcare system. They are looking to hire a Payment… more
- CenterWell (Grandview, MO)
- …**ust live within the greater Kansas City metropolitan area.** Responsible for healthcare claims accounts receivable operations in accordance with Company ... and divisional leadership, and external payers to effectively manage end-to-end claims processing activities. Performs all duties inherent in a managerial role… more
- Evolent (Salt Lake City, UT)
- …rates, turnaround times, PMPM, trend drivers), with a working knowledge of healthcare claims and reimbursement methodologies. + Experience presenting actionable ... Be Doing: + Strategic Data Analytics & Insights: Lead advanced analyses of healthcare authorization, claims , membership data, and clinical outcomes to uncover… more
- Molina Healthcare (Nampa, ID)
- …with various internal customers (eg, Provider Services, Contracting and Credentialing, Healthcare Services, Member Services, Claims ) to gather documentation ... for this position, please apply through the intranet job listing. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare … more
- Humana (Oklahoma City, OK)
- …certifications (Clinical Certifications, CPC, CCS, CFE, AHFI) + Understanding of healthcare industry, claims processing and investigative process development + ... of fraud, waste, and abuse involving providers who submit claims to Humana's Oklahoma Medicaid line of business. As...**Must be an Oklahoma resident** + 2+ years of healthcare fraud investigations and auditing experience + Knowledge of… more
- University of Southern California (Los Angeles, CA)
- …as lead programmer and technical specialist on research projects that use administrative healthcare claims data. SAS is required. The programmer is an integral ... on research projects. + Experience with health data, including large administrative healthcare claims data from Medicare or private health insurance plans.… more
- The Cigna Group (Bloomfield, CT)
- …manage annual reconciliation for pilot programs. + Derive actionable insights from healthcare data ( claims , clinical, pharmacy, externally sourced) to engage and ... + Experience with Healthcare data knowledge and hands on experience (medical claims data, clinical data, pharmacy data and eligibility data) + Knowledge of ACO,… more