- Cognizant (Atlanta, GA)
- 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
- Molina Healthcare (Atlanta, GA)
- **Job Description** **Job Summary** Provides entry level analyst support for claims research activities. This role plays a pivotal role in ensuring the timely ... and quality standards. **Job Duties** + Reviews and analyzes claims -related issues submitted by providers to identify potential root causes quickly and… more
- Prime Therapeutics (Atlanta, GA)
- …drives every decision we make. **Job Posting Title** Specialty & Home Delivery Program Claims Analyst - Remote **Job Description** The Specialty & Home Delivery ... Program Claims Analyst is responsible for serving as...processing or project lifecycle, or related roles in the healthcare or PBM industry + Must be eligible to… more
- Molina Healthcare (Atlanta, GA)
- …and work PST hours. **Job Summary** Performs research and analysis of complex healthcare claims data, pharmacy data, and lab data regarding network utilization ... and cost containment information. Evaluates, writes, and presents healthcare utilization and cost containment reports and makes recommendations based on relevant… more
- Molina Healthcare (Atlanta, GA)
- …Microsoft Azure, AWS or Hadoop. * 3-5 Years of experience with predictive modeling in healthcare quality data. * 5+ Years of experience in Analysis related to ... **Job Summary** The Lead Analyst , Quality Analytics and Performance Improvement...plan reports related to managed care data like Medical Claims , Pharmacy, Lab and HEDIS rates * Assists and… more
- Molina Healthcare (Atlanta, GA)
- …Microsoft Azure, AWS or Hadoop. + 1-3 Years of experience with predictive modeling in healthcare quality data. + 1-3 Years of experience in Analysis related to ... **Job Description** **Job Summary** The Analyst , Quality Analytics and Performance Improvement...Claims , Pharmacy, Lab and HEDIS rates. + Assist Quality department with HEDIS measure deep dive to support… more
- Molina Healthcare (Atlanta, GA)
- …Responsible for accurate and timely auditing of critical information on claims databases. Maintains critical auditing and outcome information. Synchronizes data ... among operational and claims systems and application of business rules as they...to meet changing business requirements, strong commitment to high quality , on time delivery + Previous process improvement experience… more
- Elevance Health (Atlanta, GA)
- **Senior Healthcare Economics Analyst ** **Location:** Chicago, IL; Atlanta, GA; Indianapolis, IN; Richmond, VA (preferred). This role requires associates to be ... position is not eligible for current or future visa sponsorship._ The **Senior Healthcare Economics Analyst ** (Advanced Analytics Analyst Senior) creates… more
- Evolent (Atlanta, GA)
- …**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 (Atlanta, GA)
- …accurate and timely implementation and maintenance of critical information on claims databases. Maintains critical information on claims databases. Synchronizes ... improvement processes to ensure systems are working more efficiently and improve quality . + Assists in planning and coordination of application upgrades and… more
- Emory Healthcare/Emory University (Atlanta, GA)
- …Familiarity with interdisciplinary team collaboration is essential, particularly in healthcare or psychiatric environments. The primary role of this position ... aligns with the university calendar. JOB DESCRIPTION: + Board Certified Behavioral Analyst (BCBA) II (Behavioral Clinical Practitioner BCPII ) in the Emory Autism… more
- Molina Healthcare (Atlanta, GA)
- …for accurate and timely maintenance of critical provider information on all claims and provider databases. Maintains critical provider information on all claims ... accuracy in a timely manner to meet department standards of turnaround time and quality . + Audit loaded provider records for quality and financial accuracy and… more
- Prime Therapeutics (Atlanta, GA)
- …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
- Molina Healthcare (Atlanta, GA)
- …for accurate and timely maintenance of critical provider information on all claims and provider databases. Maintains critical provider information on all claims ... management and credentialing. **KNOWLEDGE/SKILLS/ABILITIES** + Generates data to support continuous quality of provider data and developing SOPs and/or BRDs. +… more
- Evolent (Atlanta, GA)
- … quality reporting, and benchmarking + Working knowledge of healthcare claims ; specifically, differences between institutional vs professional billing and ... that fosters expertise and cooperation + Perform research and analysis of complex healthcare claims , eligibility, and pharmacy data regarding health plan cost &… more
- Norstella (Atlanta, GA)
- …seeking a Senior Medical Analyst to join our team and drive data-driven healthcare initiatives. In this role, you will leverage your expertise in healthcare ... Sr. Medical Analyst , RWD Company: MMIT Location: Remote, United States...related field. + Experience working with and querying large healthcare databases, including claims , EMR/EHR, and laboratory… more
- Prime Therapeutics (Atlanta, GA)
- …Posting Title** QA Analyst PBM Implementation - Remote **Job Description** The Quality Assurance (QA) Analyst performs complex quality reviews and serves ... GED is required + 2 years of experience within Claims Processing, Audit, Quality or Pharmacy +...Licensed Practical Nurse certification if working in Medicare + Healthcare , audit, and/or reporting and metrics environment experience +… more
- Elevance Health (Atlanta, GA)
- …to the Cost of Care and/or Provider Contracting organizations. Focuses efforts on lowering claims costs, improving the quality of care, and increasing member and ... **Provider Contract Cost of Care Analyst Senior** **Location:** This role requires associates to...of care issues to help reduce costs without compromising quality of care. **How you will make an impact:**… more
- Humana (Atlanta, GA)
- …and help us put health first** The Medicaid (PPS) Provider Hospital Reimbursement Analyst also known as a Senior Business Intelligence Engineer will be an integral ... closely with IT, the pricing software vendor, CIS BSS, Medicaid operations, claims operations, and other business teams involved in the administration of Medicaid… more
- CVS Health (Atlanta, GA)
- …Linux OS, GCP/ AWS/ Azure * Experience working with medical and/or pharmacy claims data * Experience in healthcare industry, including health insurance, PBM ... our PBM Finance Enablement group as a Senior Reporting Analyst within our PBM Customer Reporting team. CVS Health...a collaborative, close-knit team on pharmacy and member specific claims data including, but not limited to, financial and… more