- Hackensack Meridian Health (Tinton Falls, NJ)
- …serve as a leader of positive change. The Third Party Follow-Up Analyst provides statistical and financial data enabling management to accurately monitor accounts ... years of experience in a healthcare billing office or health insurance claims environment. + Familiar with common medical billing practices, concepts, and… more
- Molina Healthcare (New York, NY)
- **Job Description** **Job Summary** Sr. Analyst , Network Strategy, Pricing & Analytics guides the investment of our network partners through contract valuation and ... affordably. Performs research, financial modeling, and analysis of complex healthcare claims data (medical, pharmacy and ancillary) to deliver practical, actionable… more
- Fallon Health (Worcester, MA)
- …be the leading provider of government-sponsored health insurance programs-including Medicare, Medicaid , and PACE (Program of All-Inclusive Care for the Elderly)- in ... Twitter and LinkedIn. **Brief Summary of Purpose:** Seeking a motivated and detail-oriented analyst to join our team. This position is ideal for candidates who have… more
- Molina Healthcare (NM)
- **Job Description** **Job Summary** Sr. Analyst , Network Strategy, Pricing & Analytics guides the investment of our network partners through contract valuation and ... affordably. Performs research, financial modeling, and analysis of complex healthcare claims data (medical, pharmacy and ancillary) to deliver practical, actionable… more
- Bozeman Health (Bozeman, MT)
- Position Summary: The Credit Balance Analyst is responsible for processing refunds for third party insurance, Medicare, Medicaid , and Government-Assisted ... of all insurance and/or Government rules regarding payment, credit procedures, claims submittal and appeal process. Candidate must have excellent written and… more
- CareFirst (Baltimore, MD)
- …meetings, training and/or other business-related activities. **ESSENTIAL FUNCTIONS:** + Work with claims data retrieved from a variety of sources via Excel and ... such as auditing of contracts, responses to RFI/RFPs, researching Medicare, Medicaid and other industry policies and reimbursement methodologies. Compile fee… more
- Queen's Health System (Honolulu, HI)
- …monitoring and routine auditing of virtual inventory accumulation, purchasing procedures, Medicaid billing procedures, patient eligibility, new areas of service, and ... business units highly desirable. * Experience with retail prescription claims or hospital billing auditing highly desirable. Equal Opportunity… more
- SSM Health (MO)
- …Pharmacy Affairs (OPA) database changes and updates. + Monitors and audits state Medicaid claims to ensure compliance. + Reconciles contract pharmacy payments ... against revenue posted by Finance. + Evaluates patient eligibility in mixed use areas and clinics in electronic medical records (EMR). + Develops and updates 340B Program reporting packets for SSM ministries. + Reviews ordering, negative and positive… more
- Molina Healthcare (Racine, WI)
- …care or payer environment. + In-depth knowledge of medical and hospital claims processing, including CPT/HCPCS, ICD, and modifier usage. + Strong understanding of ... and experience with federal regulatory policy resources including Centers for Medicare & Medicaid Services (CMS) and the Affordable Care Act (ACA). + Medical Coding… more
- CVS Health (Richmond, VA)
- …complex data analyses to support investigations of potential fraud, waste, and abuse in Medicaid claims and provider activity. + Prepare timely and accurate ... We are seeking a highly analytical and detail-oriented Data Analyst to join our Special Investigation Unit within a...in healthcare fraud, waste and abuse + Knowledge of Medicaid healthcare claims adjudication (QNXT) & regulatory… more