- Commonwealth Care Alliance (Boston, MA)
- 011230 CA-Provider Engagement & Performance **Position Summary:** The HEDIS Network Analyst will support CCA's ability to meet and surpass critical Quality ... department and will have regular interaction with relevant internal Clinical, Quality , and BI departments, while frequently interfacing with Providers within CCA's… more
- Cognizant (Boston, MA)
- About the role As a ** Quality Analyst with Healthcare - Claims & Membership experience** . You will make an impact by designing and executing end-to-end ... test strategies that ensure the quality and reliability of healthcare claims and membership applications. You will be a valued member of the Quality … more
- Evolent (Boston, MA)
- …**What You Will Be Doing:** + **Data Analytics & Insights** : Analyze healthcare claims and authorization data to identify cost drivers, utilization trends, ... working seamlessly with diverse teams and stakeholders. + Familiarity with healthcare claims , reimbursement methodologies, and cost/utilization KPIs, including… more
- Molina Healthcare (Boston, MA)
- …network partners through contract valuation and analysis to ensure access to quality healthcare services for people receiving government assistance. Strengthens ... **Job Description** **Job Summary** Sr. Analyst , Network Strategy, Pricing & Analytics guides the...affordably. Performs research, financial modeling, and analysis of complex healthcare claims data (medical, pharmacy and ancillary)… more
- Fallon Health (Worcester, MA)
- …Founded in 1977 in Worcester, Massachusetts, Fallon Health delivers equitable, high- quality , coordinated care and is continually rated among the nation's top ... health plans for member experience, service, and clinical quality . We believe our individual differences, life experiences, knowledge, self-expression, and unique… more
- Prime Therapeutics (Boston, MA)
- …to determine work assignments within project + Educate and advance business systems analyst practice within the Claims IT team and across the organization ... passion and drives every decision we make. **Job Posting Title** Sr. AI Business Analyst - Remote **Job Description** **Are you a Business Systems Analyst with… more
- Commonwealth Care Alliance (Boston, MA)
- …at this time._** **Position Summary:** Reporting to the Director, Claims Operations and Quality Assurance, the Claims Sr. Analyst plays a critical role ... billing-related certifications **Required Experience (must have):** + 3+ years in healthcare claims processing, provider reimbursement, or payment integrity. +… more
- Beth Israel Lahey Health (Charlestown, MA)
- …remote based role. Reporting to the Manager, Patient Financial Services, the Clinical Analyst plays an important role in a high-profile team tasked with handling all ... commercial and government clinical appeals and audit processes. The Clinical Analyst will perform high-level clinical appeal for services in the inpatient and… more
- Beth Israel Lahey Health (Charlestown, MA)
- …Director of Epic Patient Financial Services - PB, the Senior Epic Operations Analyst serves as the preeminent Epic analytical resource tasked with improving revenue ... back-end billing functions and workflows, charge generation and capture, claims generation and reconciliation, remittance posting processes, retro adjudication and… more
- Prime Therapeutics (Boston, MA)
- …analysis to include 1 year of experience in Pharmacy Benefit Management (PBM), claims processing, healthcare , and/or related field + Must be eligible to ... our passion and drives every decision we make. **Job Posting Title** Pricing Analyst - REMOTE **Job Description** The Pricing Analyst maintains, provides… more
