- Molina Healthcare (Bowling Green, KY)
- …functionality through project inclusion and documentation review to understand proper claims processing for the applicable solution. Validates data received ... support issues related to EDI transaction editing and custom claims processes to determine root cause of issue. Gains...claims to identify billing issues that will impact claims processing and payment. Monitor new solutions implemented to… more
- Molina Healthcare (Louisville, KY)
- …Maintains critical provider information on all claims and provider databases. Synchronizes data among multiple claims systems and application of business ... rules as they apply to each database. Validate data to be housed on provider databases and ensure...and best practices while suggesting improvement processes to ensure systems are working more efficiently and improve quality. +… more
- Elevance Health (Louisville, KY)
- …** is responsible for providing support, configuration, design, testing and implementation for claims systems . Ensures accurate adjudication of claims , by ... **Pre-Pay Editing Analyst Sr ** **Location:** This role requires associates to be...and the vendor to ensure quality and timeliness of systems /project deliverables. + Configures new designs/updates in the system.… more
- Evolent (Frankfort, KY)
- …manner that fosters expertise and cooperation.** **Process and validate raw unadjudicated claims data .** **Use programming skills to explore, examine and ... **Familiarity with value-based care and utilization management- Preferred.** **Understanding of data systems and the critical thinking skills to solve… more
- Molina Healthcare (KY)
- … claims databases. Maintains critical information on claims databases. Synchronizes data among operational and claims systems and application of ... business rules as they apply to each database. Validate data to be housed on databases and ensure adherence...information into the claim payment system and other applicable systems . + Participates in defect resolution for assigned component… more
- Molina Healthcare (Lexington, KY)
- **JOB DESCRIPTION** **Job Summary** Performs research and analysis of complex healthcare claims data , pharmacy data , and lab data regarding network ... + Healthcare Analyst I or Financial/Accounting Analyst I experience desired + Multiple data systems and models + BI tools To all current Molina employees: If you… more
- Highmark Health (Frankfort, KY)
- …evaluates, and processes various Stop Loss (Excess Risk and Reinsurance) claims in accordance with established turnaround and quality standards. Responsible for ... disseminates necessary information to the management. Follows up on pended claims in accordance with department standards. HNAS (Health Now Administrative Services)… more
- Humana (Louisville, KY)
- …our caring community and help us put health first** Humana is seeking a Senior Data and Reporting Professional for the HealthCare Economics (HCE) department. HCE ... Power BI reports and other mediums as appropriate. The Senior Data and Reporting Professional integrates ...analysis + Proficiency in SAS, SQL, Databricks and/or other data systems + Advanced Microsoft Excel skills… more
- Datavant (Frankfort, KY)
- …designing, developing, and maintaining robust data pipelines for healthcare data including prescriptions, medical claims , MAO4, patient demographics, and ... with the other engineering teams to troubleshoot issues with API's and data exchanges between multiple systems . **What You Need to Succeed** + 5+ years Data … more
- Otsuka America Pharmaceutical Inc. (Frankfort, KY)
- **Position Summary** The Senior Manager of Field Technology will lead the design, optimization, and delivery of field sales reporting platforms and tools. This role ... in ensuring that our field teams have seamless access to accurate, actionable data to drive performance. The role focuses on managing field-facing technology … more