• Sr Claims Systems Data…

    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 (07/12/25)
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  • Mgr Medical Affairs - Clinical Development…

    Canon USA & Affiliates (Frankfort, KY)
    **Mgr Medical Affairs - Clinical Development Sr - HIT - req1494** **OVERVIEW** Works independently and as part of a dynamic and fast-paced team of clinical and ... and review of collaterals for clinical accuracy and adherence to clinical claims . Effectively interacts with multiple teams including R&D, global and local business,… more
    Canon USA & Affiliates (07/14/25)
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  • Sr . Manager, Medicaid Contract…

    Sumitomo Pharma (Frankfort, KY)
    …computer systems . + Identifies and resolves discrepancies in submitted data invoices to ensure legitimacy of contract discounts. + Ensures detailed accuracy ... highly motivated, and experienced individual for the position of Sr . Manager, Medicaid Contract Administration. This position is responsible...of correct data input into company systems . + Maintains… more
    Sumitomo Pharma (07/09/25)
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  • Sr Product Owner

    Evolent (Frankfort, KY)
    …mission. Stay for the culture. **What You'll Be Doing:** Evolent Health is looking for a Sr . Product Owner within our Common Data portfolio to be a key member of ... a technical field or relevant related field + Understanding of healthcare data formats (eg, eligibility, claims , configuration, authorizations, clinical data… more
    Evolent (06/17/25)
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  • Sr Analyst, Performance Suite Analytics

    Evolent (Frankfort, KY)
    …data using industry-standard metrics. + Process and validate raw unadjudicated claims data . **Qualifications Required and Preferred:** + Bachelor's degree, ... Familiarity with value-based care and utilization management is preferred + Understanding of data systems and the critical thinking skills to solve new problems… more
    Evolent (06/24/25)
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  • Sr QNXT Analyst - Contracts

    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 (06/22/25)
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  • Sr Product Owner

    Evolent (Frankfort, KY)
    …skills + Microsoft Office experience (Excel, Visio) + Understanding of healthcare data formats (eg, eligibility, claims , configuration, authorizations, clinical ... You'll Be Doing:** Evolent Health is looking for a Senior Product Owner to be a key member of...key member of the Product team, focused on client data integrations. This individual will play a critical role… more
    Evolent (07/09/25)
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  • Senior Analyst, Healthcare - Claims…

    Molina Healthcare (Covington, KY)
    …Multiple data systems and models + Complex database and data management responsibilities + Claims processing background + Configuration background To all ... **Job Summary** Performs research and analysis of complex healthcare claims data , pharmacy data , and...and ancillary providers. + Implement and use software and systems to support the department's goals. + Strong knowledge… more
    Molina Healthcare (07/09/25)
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  • Clinical Documentation and Claims Integrity…

    Elevance Health (Louisville, KY)
    …rules. **Preferred Skills, Capabilities, and Experience:** + Experience working with encounter data systems within a healthcare payer or RCM organization and ... **Clinical Documentation and Claims Integrity Director** **Location:** Alternate locations may be...to ensure high quality encounter submissions. + Liaises with senior CareBridge and Elevance Health leadership across Product, Analytics,… more
    Elevance Health (07/18/25)
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  • Senior Internal Business Systems…

    Highmark Health (Frankfort, KY)
    …BE A US CITIZEN This position serves as a key liaison between Claims Operations, Customer Service, Regulatory Affairs, IT, Legal and other departments, proactively ... of applications he/she supports, how users use the application, and what other systems integrate with the application. Understands how work is being conducted, and… more
    Highmark Health (07/11/25)
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