- Knox Community Hospital (Mount Vernon, OH)
- …Performs concurrent and retrospective reviews of patient records to abstract data for identified quality performance indicators. Compiles and organizes data ... MIPS ) and alternative payment models offered by Centers for Medicare and Medicaid Services (CMS) and patient centered medical home models. Ability to collect,… more
- Humana (Columbus, OH)
- …our organization's standing within the Medicaid markets. **Complex Ad-Hoc Requests:** The Data and Reporting Professional 2 will address complex ad-hoc ... caring community and help us put health first** The Medicaid Data and Reporting Analyst...operating objectives, including their linkages to related areas. The Data and Reporting Professional 2… more
- Humana (Columbus, OH)
- …etc. Partner with actuarial, financial, and clinical teams to align on data definitions, methodologies, and reporting . Identify cost drivers, utilization ... patterns, and anomalies in Medicaid medical claims data . Maintain dashboards to...degree, recent and relevant work experience, and/or other relevant professional designations. + MAAA + Strong communication skills +… more
- Humana (Columbus, OH)
- …of our caring community and help us put health first** The Senior Agency Professional ; Finance & Accounting supports data analysis related to compliance and ... determine the best course of action. The Senior Agency Professional ; Finance & Accounting provides support for handling and...Finance & Accounting provides support for handling and analyzing data that pertains to the compliance and commissions of… more
- CVS Health (OH)
- …abuse + Knowledge of Medicaid healthcare claims adjudication (QNXT) & regulatory reporting + Experience with data visualization tools (eg, Tableau, Power BI ... a full time role and is ideal for a data professional with strong coding skills in...to support fraud, waste, and abuse (FWA) detection and Medicaid regulatory & compliance reporting . This is… more
- Humana (Columbus, OH)
- …our caring community and help us put health first** The Supply Chain Budget Professional reports to the Director of Enterprise Print Management (EPM) and plays a key ... Print and Postage operations through effective budget development, management, financial reporting , and cost tracking. This position ensures accuracy and efficiency… more
- Humana (Columbus, OH)
- …and overall market sales support. The ideal candidate will be able to summarize reporting data and present ideas and results. If you are detail oriented ... and help us put health first** The Sales Support Professional 1 will provide sales support to the Large...high level of accountability + Synthesizing and analyzing financial data (ex. budgets and income statement forecasts) with consideration… more
- Molina Healthcare (Dayton, OH)
- …coordination, and shared ownership of high-value deliverables-distinct from a pure data analyst role. **Job Duties** **Business Leadership & Operational Ownership** ... Assists and executes tasks and projects to ensure Centers for Medicare & Medicaid Services (CMS) and State regulatory requirements are met for Pre-pay Edits,… more
- Medical Mutual of Ohio (OH)
- …of Healthcare Providers and Systems (CAHPS) and Health Outcomes Survey (HOS). Supports data capture and reporting of clinical quality of care received by ... database reporting (SQL) and analytics programming languages (SAS) and data visualization tools such as Tableau. **Sr HEDIS Analyst** **Education and… more
- Bon Secours Mercy Health (Cincinnati, OH)
- …optimize workflows and enhance performance through provider engagement, patient outreach, EHR reporting /tools, and data analysis. This is a remote/work at home ... education on quality metric specifications, EHR workflows, payer requirements, and data analysis/ reporting . + Develops and implements innovative processes and… more
- Elevance Health (Cincinnati, OH)
- …and track the key performance metrics for assigned providers, ensuring data -driven decision-making. + **Documentation and Reporting :** Accurately document all ... join our team and drive the achievement of value-based care in the Medicare, Medicaid , and Commercial lines of business. The ideal candidate will be responsible for… more
- Elevance Health (Cincinnati, OH)
- …requirements from internal and external requestors to ensure that the team is meeting reporting needs and facilitates seamless data transfer. + Develops ad hoc ... studies related to risk adjustment analytics in both the Medicaid and Medicare Advantage lines of business. **How You... and Medicare Advantage risk adjustment initiatives. + Performs data mining and data -driven analyses to evaluate… more
- Trinity Health (Grove City, OH)
- …coinsurance and deposits. Gathers and evaluates confidential patient financial data for purposes of determining patient qualification for financial assistance ... ICD-9 coding to ensure compliance with third party regulations. Understands Medicare, Medicaid and other third party information requirements and adheres to all… more
- Molina Healthcare (Columbus, OH)
- …of programs for members in accordance with prescribed quality standards; conducts data collection, reporting and monitoring for key performance measurement ... wide. These functions include, but may not be limited to: Quality Reporting , HEDIS Performance Measurement, Clinical Quality Interventions, and QI Compliance. +… more
- Cardinal Health (Columbus, OH)
- …leaders and employees and proactively provides guidance and trainings on policies. Reporting to the Director, Ethics & Compliance, this position supervises and ... manages audits to determine organizational integrity of billing for professional (physician) services and/or hospital (technical) services, including: detection and… more
- Molina Healthcare (Dayton, OH)
- …(SIU) Investigator is responsible for supporting the prevention, detection, investigation, reporting , and when appropriate, recovery of money related to health care ... investigations, including but not limited to witness interviews, background checks, data analytics to identify outlier billing behavior, contract and program… more
- Lundbeck (Cleveland, OH)
- …fully integrated account plans + Strong analytical background, and experience using sales data reporting tools to identify trends + Experience in product ... Heights and North Olmstead. **SUMMARY:** Are you a results-driven biopharmaceutical sales professional looking to be part of an organization that values being… more
- Cleveland Clinic (Cleveland, OH)
- …maintain and enhance databases and applications for internal purposes and customer reporting . + Administer existing databases and the analysis, design and creation ... of new databases. + Perform data modeling, database optimization, understanding and implementation of schemas and the ability to interpret and write complex code. +… more
- Molina Healthcare (Columbus, OH)
- …timeline is being followed. Communicates project status through weekly reporting , project status meetings, and leadership presentations. Manages the project ... PM experience in Managed Care Operations (claims, system configuration, provider data management preferred) + Demonstrated ability to solicit and formally document… more
- Elevance Health (Mason, OH)
- …Access Specialist** , you will be responsible for the interpretation and data entry of basic prescriptions, handling medication access issues, and troubleshooting ... members through the appeals process when necessary. + **Documentation and Reporting ** : Accurately document member interactions and generate reports relating to… more
