- 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
- AmeriHealth Caritas (Charleston, SC)
- …+ Requests/runs queries to identify root causes of claim denials, incorrect payments and claims that are not correctly submitted for payment. + Act as the resource ... experience preferred. + Required ability to focus on technical claims processing and Provider data maintenance knowledge. + Required...or related experience preferred. + 1 to 2 years Medicaid experience preferred. + 2 to 5 years of… 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
- City of New York (New York, NY)
- Job Description APPLICANTS MUST BE PERMANENT IN THE ADMINISTATIVE STAFF ANALYST CIVIL SERVICE TITLE OR BE PERMANENT IN A COMPARABLE TITLE ELIGIBLE FOR 6.1.9 TITLE ... assistance with applying for public benefits and services including Medicaid , food stamps and cash assistance. HASA also provides...Administration (HASA) is recruiting for one (1) Admin Staff Analyst NMI to function as Director of Budget and… more