- Actalent (Boston, MA)
- Senior Medicare Coverage Analyst As a Senior Medicare Coverage Analyst , you will mentor and train junior staff, ensuring their work aligns with the ... accuracy required in Medicare coverage analysis. You will serve as the expert...coverage analysis. You will serve as the expert on Medicare policies, specifically NCD/LCD, and create detailed coverage analyses… more
- Dana-Farber Cancer Institute (Brookline, MA)
- …is fully remote with the ocassional time onsite as needed.** The Sr. Medicare Coverage Analyst (MCA) is responsible for reviewing clinical research protocols, ... and which should be billed to the study sponsor. The Medicare Coverage Analyst determines whether proposed clinical research studies are a Qualifying Clinical… more
- SUNY Upstate Medical University (Syracuse, NY)
- Job Summary: The Medicare Coverage Analyst functions as a key contact person between UMU clinical research departments and sites/hospitals finance for clinical ... trials coverage analyses (CTCA) issues to ensure billing compliance and mitigate risk; reviews budgets on a per-trial basis to ensure accuracy; develop CTCAs timely; documents and disseminates CCA determinations. ensures that final contract terms are… more
- Insight Global (Woonsocket, RI)
- …Bach degree or equivalent 2-4 years or more years of Technical Business Analyst experience Medicare or Health Insurance experience: claims, member benefits, ... Job Description Insight Global is seeking a Technical Business Analyst to support a large health insurance client of ours. Work with business partners and technical… more
- Elevance Health (Woodbridge, NJ)
- ** Medicare Risk Adjustment Advanced Analytics Analyst ** **On-Site Requirement: Hybrid 1;** **This role requires associates to be in-office 1 - 2 days per week,** ... an accommodation is granted as required by law._ The ** Medicare Risk Adjustment Advanced Analytics Analyst ** is...law._ The ** Medicare Risk Adjustment Advanced Analytics Analyst ** is responsible for employing advanced analytics to gain… more
- BlueCross BlueShield of North Carolina (NC)
- …of degree, 7+ years of experience in related field **Bonus Points** + Deep Medicare and/or Medicare Advantage regulatory experience + Extensive Medicare / ... Medicare Advantage investigative experience **What You'll Get** + The opportunity to work at the cutting edge of health care delivery with a team that's deeply invested in the community + Work-life balance, flexibility, and the autonomy to do great work +… more
- Healthfirst (NY)
- …of material reviews in HPMS. + Actively participates in the annual Medicare Go to Market process, including working with internal stakeholders on developing ... deliverables as needed. + Assists in the preparation of Medicare Part C and D reporting via HPMS, including...knowledge of Microsoft Office Suite applications. + Knowledge of Medicare and CMS guidelines as it relates to member… more
- Molina Healthcare (Sterling Heights, MI)
- …business analysis, task and workflow analysis. + Subject matter expert of Medicare and Healthcare enrollment 834 files. + Interpret customer business needs and ... translate them into application and operational requirements + Communicate and collaborate with external and internal customers to analyze and transform needs, goals and transforming in to functional requirements and delivering the appropriate artifacts as… more
- Molina Healthcare (Tampa, FL)
- **JOB DESCRIPTION** **Job Summary** Responsible for Medicare risk adjustment related estimates, establishing premium rates, financial analysis, and reporting. ... Extracts, analyzes, and synthesizes data from various sources to identify risks. Maintain/update SQL model(s), estimate risk scores, and analyze impact. **KNOWLEDGE/SKILLS/ABILITIES** + Collaborate with Actuarial staff to calculate risk adjustment payment… more
- UCLA Health (Los Angeles, CA)
- Description As the Business Data Analyst for our Medicare Advantage Risk Adjustment team, you will be responsible for producing accurate and insightful ... department measurements used in both internal and external reporting. You will: + Ensure data quality and accuracy through rigorous assurance checks. + Develop and maintain reports, from ad hoc requests to scheduled production reports. + Write clear… more