- Molina Healthcare (Racine, WI)
- …functionality through project inclusion and documentation review to understand proper claims processing for the applicable solution. Validates data received ... support issues related to EDI transaction editing and custom claims processes to determine root cause of issue. Gains...claims to identify billing issues that will impact claims processing and payment. Monitor new solutions implemented to… more
- Canon USA & Affiliates (Madison, WI)
- **Mgr Medical Affairs - Clinical Development Sr - HIT - req1494** **OVERVIEW** Works independently and as part of a dynamic and fast-paced team of clinical and ... and review of collaterals for clinical accuracy and adherence to clinical claims . Effectively interacts with multiple teams including R&D, global and local business,… more
- Sumitomo Pharma (Madison, WI)
- …computer systems . + Identifies and resolves discrepancies in submitted data invoices to ensure legitimacy of contract discounts. + Ensures detailed accuracy ... highly motivated, and experienced individual for the position of Sr . Manager, Medicaid Contract Administration. This position is responsible...of correct data input into company systems . + Maintains… more
- Evolent (Madison, WI)
- …mission. Stay for the culture. **What You'll Be Doing:** Evolent Health is looking for a Sr . Product Owner within our Common Data portfolio to be a key member of ... a technical field or relevant related field + Understanding of healthcare data formats (eg, eligibility, claims , configuration, authorizations, clinical data… more
- Evolent (Madison, WI)
- …data using industry-standard metrics. + Process and validate raw unadjudicated claims data . **Qualifications Required and Preferred:** + Bachelor's degree, ... Familiarity with value-based care and utilization management is preferred + Understanding of data systems and the critical thinking skills to solve new problems… more
- Evolent (Madison, WI)
- …Familiarity with value-based care and utilization management is preferred + Understanding of data systems and the critical thinking skills to solve new problems ... interactions fostering expertise and cooperation. + Extract, manage, and analyze claims and operational data using industry-standard metrics. **Qualifications… more
- Molina Healthcare (Milwaukee, WI)
- … 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...information into the claim payment system and other applicable systems . + Participates in defect resolution for assigned component… more
- Evolent (Madison, WI)
- …skills + Microsoft Office experience (Excel, Visio) + Understanding of healthcare data formats (eg, eligibility, claims , configuration, authorizations, clinical ... You'll Be Doing:** Evolent Health is looking for a Senior Product Owner to be a key member of...key member of the Product team, focused on client data integrations. This individual will play a critical role… more
- Elevance Health (Waukesha, WI)
- …rules. **Preferred Skills, Capabilities, and Experience:** + Experience working with encounter data systems within a healthcare payer or RCM organization and ... **Clinical Documentation and Claims Integrity Director** **Location:** Alternate locations may be...to ensure high quality encounter submissions. + Liaises with senior CareBridge and Elevance Health leadership across Product, Analytics,… more
- Highmark Health (Madison, WI)
- …BE A US CITIZEN This position serves as a key liaison between Claims Operations, Customer Service, Regulatory Affairs, IT, Legal and other departments, proactively ... of applications he/she supports, how users use the application, and what other systems integrate with the application. Understands how work is being conducted, and… more
- Molina Healthcare (Racine, WI)
- …Risk Adjustment Actuarial team. Responsibilities include research, analysis and modeling of complex healthcare claims data , pharmacy data , lab data , and ... **JOB DESCRIPTION** **Job Summary** This Sr . Analyst, Healthcare Analytics role will be responsible...I or Financial/Accounting Analyst I experience desired + Multiple data systems and models + Data… more
- Molina Healthcare (Racine, WI)
- … systems to support executive decision-making + Mine and manage information from large data sources. + Analyze claims and other data sources to identify ... **JOB DESCRIPTION** **Job Summary** The Senior Analyst, Medical Economics provides support and consultation...evaluate the impact of provider reimbursement changes + Provide data driven analytics to Finance, Claims , Medical… more
- Otsuka America Pharmaceutical Inc. (Madison, WI)
- …Operational Support will be responsible for managing and enhancing platform integrations across data systems , Salesforce Health Cloud and other CRM systems , ... and related CRM system integrations with internal and external systems , data platforms, and analytics solutions. +...you will be reimbursed, this is not Otsuka. These claims are fraudulent and you are strongly advised to… more
- Elevance Health (Waukesha, WI)
- … data mining, entity review, law enforcement referral, and use of proprietary data and claim systems for review of facility, professional and pharmacy ... **Investigator Senior ** _Hybrid 1: This role requires associates to...to recover corporate and client funds paid on fraudulent claims . **How you will make an impact:** + Claim… more
- Walgreens (Wauwatosa, WI)
- …by Pharmacy Manager, Staff Pharmacist and Store Manager including utilizing pharmacy systems to enter patient and drug information, ensuring information is entered ... the pharmacist, including those to physicians. Processes (corrects and resubmits) manual claims for third party program prescription services in a timely and… more
- Highmark Health (Madison, WI)
- …overall business targets or assigned volume of new applications or RFP's.Utilize various systems and tools to obtain necessary data and accurately complete and ... quotes and analyzes the structure of a contract for a group based on claims experience, characteristics of the employee groups, etc. The incumbent uses discretion of… more
- Thrivent Financial (WI)
- …matters. + Obtain, organize, maintain, protect, and manage secure private and confidential data within our systems . + Attend all Thrivent office professional ... practice for Thrivent in Central Wisconsin, is looking for a full-time Senior Client Services Administrator (CSA) focused on application processing and related work… more
- Otsuka America Pharmaceutical Inc. (Madison, WI)
- …- Interacts effectively with internal/external functional business units to gather data and develop documentation required for on-time submissions. - Works closely ... (Word, Excel, PowerPoint, Outlook) and familiarity with electronic document management systems (EDMS). **Competencies** See OPDC Competencies Chart (Level X) **P**… more
- Trek Bikes (Waterloo, WI)
- …vendors. Insurance Support + Assist with annual insurance renewals, coordinating data collection and submissions. + Support insurance claims processing, ... Job Description Position Summary: We are seeking an experienced and adaptable Senior Treasury Analyst to join our dynamic, fast-paced Treasury team. This individual… more
- CVS Health (Madison, WI)
- …Salesforce. + Market and place stop loss policies, negotiating terms based upon claims data , strategy, relationships and cost avoidance/reduction efforts. + Work ... impacts for custom requests. + Manage and interpret operational data and apply to fee development and financial analysis....Meritain products and services along with strong business and systems knowledge. + Reviews work for accuracy and recommends… more