- Elevance Health (Louisville, KY)
- ** Medical Claims Data Integrity Consultant** **Location:** Atlanta, GA; Norfolk, VA; Indianapolis, IN; Chicago, IL; Louisville, KY (preferred). This role ... position is not eligible for current or future visa sponsorship._ The ** Medical Claims Data Integrity Consultant** (Business Information Developer… more
- Prysmian (Highland Heights, KY)
- …accounting support to suppliers. + Responsible for accuracy, timelines, and the general integrity of the accounting data (including suppliers master data ) ... of optical fibers, copper cables and connectivity for voice, video and data transmission for the telecommunication sector._ _We are 30,000 employees, across 50+… more
- Waystar (Louisville, KY)
- …Provided leadership on a team that designed, built, or used RCM Revenue Integrity products + Ability to interpret regulatory guidelines from CMS, Tricare, and ... Waystar's healthcare payments platform combines innovative, cloud-based technology, robust data , and unparalleled client support to streamline workflows and improve… more
- Elevance Health (Louisville, KY)
- …fraud and abuse prevention and control. + Review and conducts analysis of claims and medical records prior to payment. Researches new healthcare-related ... **Clinical Fraud Investigator II - Registered Nurse and CPC - Calrelon Payment Integrity SIU** **Location:** This role requires associates to be in-office 1 - 2 days… more
- Humana (Frankfort, KY)
- …and reporting. Identify cost drivers, utilization patterns, and anomalies in Medicaid medical claims data . Maintain dashboards to communicate key ... trends to stakeholders. The Actuary, Analytics/Forecasting ensures data integrity by developing and executing necessary processes and controls around the flow of… more
- Otsuka America Pharmaceutical Inc. (Frankfort, KY)
- …Commercial third-party data assets, including Xponent Plantrak, DDD, HCOS, Claims Data , Specialty pharma, omnichannel data , SalesForce/Veeva ... **Job Summary** The Associate Director (AD), Commercial Data Management (CDM) within Data Enablement (DE) for Business Analysis (BA) is accountable for… more
- CVS Health (KY)
- …drivers. + Perform root cause analysis on quality measure performance, identifying data integrity issues, coding discrepancies, and operational inefficiencies. + ... & Quality Data Analysis: + Analyze large datasets from health plans (eg, claims , encounters, clinical data ) to identify HEDIS gaps and performance trends. +… more
- Norstella (Frankfort, KY)
- …querying and analyzing a wide range of healthcare data sources, including claims , lab results, electronic medical records (EMR), and other real-world data ... Norstella's newest service offerings leveraging Norstella's unified Real World Data asset, a combination of claims , lab,...data into structured formats suitable for analysis, ensuring data quality and integrity throughout the process… more
- Molina Healthcare (Covington, KY)
- …criteria for medical necessity. + Participates in and maintains the integrity of the appeals process, both internally and externally. Responsible for the ... claims and appeals and resolves grievances related to medical quality of care. + Attends or chairs committees...needed. + Fosters Clinical Practice Guideline implementation and evidence-based medical practice. + Utilizes IT and data … more
- Walmart (Louisville, KY)
- …area in accordance with company policies and procedures by properly handling claims and returns utilizing equipment to perform a variety of merchandising functions ... fulfillment process when necessary by processing information for thirdparty insurance claims rescanning illegible images alerting patients to inventory that is out… more