- Centene Corporation (Raleigh, NC)
- …area of compliance ; in particular HIPAA, and state regulations. Experience with Medicare claims , specifically Medical Claims Part C and Provider Network, ... workplace flexibility. **Position Purpose:** Assist in maintaining Centene Corporation's Compliance Program; guide special projects; provide regulatory interpretation; perform… more
- Commonwealth Care Alliance (Boston, MA)
- …Sr. Director, TPA Management and Claims Compliance , Healthcare Medical Claims Coding Sr. Analyst will be responsible for developing prospective claims ... reimbursement, public health care programs and reimbursement methodologies (Medicaid and Medicare ) + Medical Coding, Compliance , Payment Integrity and Analytics… more
- Commonwealth Care Alliance (Boston, MA)
- …Summary:** Reporting to the Director, Claims Operations and Quality Assurance, the Claims Sr. Analyst plays a critical role in ensuring accurate, compliant, ... resolution of complex reimbursement issues - including underpayments, overpayments, and disputes. The Claims Sr. Analyst serves as a subject matter expert on… more
- Molina Healthcare (Caldwell, ID)
- …duties or special projects as required. + Must have experience working in Medicare + Must have experience analyzing claims . **Job Qualifications** **REQUIRED ... to the Health Care environment **Job Duties** The Operational/Regulatory Oversight Sr. Analyst works with health plans and operations departments to assess, oversee,… more
- Mount Sinai Health System (New York, NY)
- …and contract compliance related to Facility Contracts for all Commercial, Medicare Advantage and Medicaid Managed Care Plans. The team serves as MSHP's subject ... Mount Sinai Health System. MSHP seeks a Senior Contract Compliance (Professional Billing) Analyst who will primarily...Monitor contract terms and conditions for adherence across all claims , identifying patterns of non- compliance . * Conduct… more
- Medical Mutual of Ohio (OH)
- …insured and self-funded group coverage, including stop loss, as well as Medicare Advantage, Medicare Supplement, and individual plans. **Supports corporate and ... lifecycle processes for all lines of business (Commercial, Marketplace, Medicare Advantage, and Medicaid), including HEDIS audit submission, Consumer Assessment… more
- Option Care Health (Bannockburn, IL)
- …the best and brightest talent in healthcare. **Job Description Summary:** The Analyst , Compliance Auditing, Monitoring and Analytics is responsible for ... techniques to analyze large datasets, such as related to healthcare operations, billing, claims , and patient information to support Compliance activities and to… more
- Prime Therapeutics (Santa Fe, NM)
- …our passion and drives every decision we make. **Job Posting Title** Sr. Compliance Analyst - Remote **Job Description** The Regulatory Inquiry & Complaints ... Senior Compliance Analyst assists in the implementation of...stakeholders to research and resolve regulatory inquiries/complaints related to claims , contracting and pharmacy reimbursement. Works directly with business… more
- Molina Healthcare (Dayton, OH)
- …Description** **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
- Prime Therapeutics (Baton Rouge, LA)
- …to determine work assignments within project + Educate and advance business systems analyst practice within the Claims IT team and across the organization ... Pharmacy Benefit Management (PBM) or healthcare experience with understanding of Medicare , Medicaid, the Exchanges along with regulatory compliance requirements… more