- Molina Healthcare (Albany, NY)
- …accurate and timely implementation and maintenance of critical information on 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 to business and system requirements of customers as it pertains to contracting,… more
- Molina Healthcare (Albany, NY)
- **Job Description** **Job Summary** We are seeking a highly experienced Lead Analyst , Configuration Oversight to support our Payment Integrity and Claims ... identify and troubleshoot claim discrepancies by utilizing benefit and provider contracts, regulatory requirements and various claims related resources + Strong… more
- Molina Healthcare (Albany, NY)
- …**Job Summary** Provides lead level support as a highly capable business analyst who serves as a key strategic partner in driving health plan financial ... and executing operational initiatives tied to Payment Integrity (PI) and provider claims accuracy. The individual will be relied upon to make independent, informed… more
- Molina Healthcare (Albany, NY)
- …work PST hours. **Job Summary** Performs research and analysis of complex healthcare claims data, pharmacy data, and lab data regarding network utilization and cost ... by various internal departments, or in support of requests from regulatory agencies, contracting agencies, or other external organizations. + Maintains SharePoint… more
- Highmark Health (Albany, NY)
- …MUST BE A US CITIZEN This position serves as a key liaison between Claims Operations, Customer Service, Regulatory Affairs, IT, Legal and other departments, ... proactively identifying, assessing, and mitigating compliance risks. The Analyst will monitor regulatory changes, interpret their impact on operational… more
- CVS Health (Albany, NY)
- …opportunity to join our PBM Finance Enablement group as a Senior Reporting Analyst within our PBM Customer Reporting team. CVS Health strives to continuously ... work with a collaborative, close-knit team on pharmacy and member specific claims data including, but not limited to, financial and operational information… more
- MVP Health Care (Schenectady, NY)
- …and continuous improvement. To achieve this, we're looking for a **Professional, Quality Analyst ** to join #TeamMVP. This is the opportunity for you if you have ... quality data highly preferred + Subject matter expertise in healthcare data- claims , coding, HIE's etc. Experience with quality metrics, (NCQA HEDIS and NYS… more
- Highmark Health (Albany, NY)
- …5 years with coding languages, analytical software, systems, tools and processes using claims , clinical, enrollment and provider data + 3 years of project leadership ... and non-technical, and internal and external audiences, and the ability to lead through influence + Healthcare industry expertise and experience, knowledge about the… more
- Trinity Health (Albany, NY)
- …healing presence within our communities. **POSITION SUMMARY** The Clinical Risk Management Analyst is responsible for the overall patient safety and clinical risk ... management and administrative skills. Broad-based knowledge of hospital related regulatory compliance requirements. Presentation skills, team player, ability to… more
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