- Independent Living Systems (Miami, FL)
- We are seeking a Senior Business Analyst to join our team at Independent Living Systems (ILS). ILS, along with its affiliated health plans known as Florida Community ... maximizing independence for all vulnerable populations. About the Role: The Senior Business Analyst in Health Care Services plays a pivotal role in bridging the gap… more
- 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
- MyFlorida (Largo, FL)
- HEALTH DATA ANALYST - 50000056 Date: Oct 2, 2025 The State Personnel System is an E-Verify employer. For more information click on our E-Verify Website ... No: 862327 Agency: Veterans Affairs Working Title: HEALTH DATA ANALYST - 50000056 Pay Plan: Career Service Position Number:...Systems. + Knowledge of State of Florida Medicaid and Medicare /CMS federal laws, rules, regulations related to Long Term… more
- Fair Haven Community Health Care (New Haven, CT)
- …Hands-on EHR data (Epic/Clarity/Caboodle, eClinicalWorks, NextGen, Athena, etc.) and/or claims data (Medicaid/ Medicare /commercial). + Working knowledge of eCQMs, ... of ability to pay. Job purpose The Senior Data Analyst turns clinical, operational, and financial data into insights...data across EHR, population health tools, 340B program, and payer/ claims . + Define and implement data quality checks, lineage,… more
- UPMC (Pittsburgh, PA)
- …through Friday daylight hours with a remote schedule. The Clinical Trial Coverage Analyst is responsible for ensuring the financial compliance and proper ... protocols to distinguish billable versus non-billable items and services. + Ensure compliance with Medicare 's Clinical Trial Policy and other payer regulations… more
- UCLA Health (Los Angeles, CA)
- Description The Business Data Analyst plays a key role within the Medicare Advantage Operations team, acting as a liaison between business units, IT teams, and ... operations, and driving system enhancements to improve efficiency and compliance . The analyst will also support testing,...required + Minimum of five years' experience in a Medicare or Managed Care environment managing enrollment, claims… more
- CVS Health (Phoenix, AZ)
- … Medicare Part-D Compliance Audit Programs, review pharmacy submitted Medicare claims , make independent decisions, and call network pharmacies to audit ... to join a specialized team of auditors as part of CVS Caremark's extensive Pharmacy Audit division. The Medicare Pharmacy Claims Auditor will administer assigned… more
- UCLA Health (Los Angeles, CA)
- Description As a member of the Medicare Advantage Operations team, Business Data Analyst is instrumental in independently developing the detailed requirements ... other related field required + Minimum of five (5) years' experience in a Medicare or Managed Care environment managing enrollment, claims or encounters required… more
- Catholic Health Services (Rockville Centre, NY)
- …Health was named Long Island's Top Workplace! Job Details The Senior Financial Analyst reports to the Reimbursement team within the Corporate Finance department, and ... for analyzing and optimizing healthcare reimbursement strategies and ensuring compliance with payer regulations and government reimbursement methodologies. This… more
- DOCTORS HEALTHCARE PLANS, INC. (Coral Gables, FL)
- Position Purpose: The Analyst - Fraud, Waste & Abuse (FWA) provides leadership in in the investigation of potential FWA cases; its main goal is aimed at detection ... of FWA activity + Develop strategies to mitigate fraud risk and ensuring compliance with regulatory requirements + Maintain process integrity and ensure legitimate … more
- CVS Health (CT)
- …data and documentation across multiple lines of business and jurisdictions. The analyst collaborates closely with investigative teams, legal, compliance , and ... And we do it all with heart, each and every day. The **Senior RFI Analyst ** within the Special Investigations Unit (SIU) plays a key role in supporting fraud, waste,… more
