- Dana-Farber Cancer Institute (Brookline, MA)
- …is fully remote with the ocassional time onsite as needed.** The Sr. Medicare Coverage Analyst (MCA) is responsible for reviewing clinical research protocols, ... and which should be billed to the study sponsor. The Medicare Coverage Analyst determines whether proposed clinical research studies are a Qualifying Clinical… more
- SUNY Upstate Medical University (Syracuse, NY)
- Job Summary: The Medicare Coverage Analyst functions as a key contact person between UMU clinical research departments and sites/hospitals finance for clinical ... trials coverage analyses (CTCA) issues to ensure billing compliance and mitigate risk; reviews budgets on a per-trial basis to ensure accuracy; develop CTCAs timely; documents and disseminates CCA determinations. ensures that final contract terms are… more
- Insight Global (Woonsocket, RI)
- …Bach degree or equivalent 2-4 years or more years of Technical Business Analyst experience Medicare or Health Insurance experience: claims, member benefits, ... Job Description Insight Global is seeking a Technical Business Analyst to support a large health insurance client of ours. Work with business partners and technical… more
- Elevance Health (Mendota Heights, MN)
- ** Medicare Risk Adjustment Actuarial Analyst III** **On-Site Requirement: Hybrid 1;** **This role requires associates to be in-office 1 - 2 days per week,** ... an accommodation is granted as required by law._ The ** Medicare Risk Adjustment Actuarial Analyst III** is...by law._ The ** Medicare Risk Adjustment Actuarial Analyst III** is responsible for completing diverse and complex… more
- CVS Health (Austin, TX)
- …Aetna, a CVS Health company, is seeking an analytical professional to join the Medicare Sales and Strategy team. The role involves supporting the Medicare Sales ... Server. Additionally, we are specifically seeking a professional with experience in Medicare Supplement. **Required Qualifications** Minimum 3 years of Medicare … more
- BlueCross BlueShield of North Carolina (NC)
- …of degree, 7+ years of experience in related field **Bonus Points** + Deep Medicare and/or Medicare Advantage regulatory experience + Extensive Medicare / ... Medicare Advantage investigative experience **What You'll Get** + The opportunity to work at the cutting edge of health care delivery with a team that's deeply invested in the community + Work-life balance, flexibility, and the autonomy to do great work +… more
- Healthfirst (NY)
- …of material reviews in HPMS. + Actively participates in the annual Medicare Go to Market process, including working with internal stakeholders on developing ... deliverables as needed. + Assists in the preparation of Medicare Part C and D reporting via HPMS, including...knowledge of Microsoft Office Suite applications. + Knowledge of Medicare and CMS guidelines as it relates to member… more
- Molina Healthcare (Boise, ID)
- …to the Health Care environment. **Knowledge/Skills/Abilities** The Operational/Regulatory Oversight Analyst works with health plans and operations departments to ... to and compliance with State and Federal regulatory guidelines. The Analyst develops and performs audits and oversight functions involving business-critical… more
- Molina Healthcare (Sterling Heights, MI)
- …business analysis, task and workflow analysis. + Subject matter expert of Medicare and Healthcare enrollment 834 files. + Interpret customer business needs and ... translate them into application and operational requirements + Communicate and collaborate with external and internal customers to analyze and transform needs, goals and transforming in to functional requirements and delivering the appropriate artifacts as… more
- Molina Healthcare (Des Moines, IA)
- **JOB DESCRIPTION** **Job Summary** Responsible for Medicare risk adjustment related estimates, establishing premium rates, financial analysis, and reporting. ... Extracts, analyzes, and synthesizes data from various sources to identify risks. Maintain/update SQL model(s), estimate risk scores, and analyze impact. **KNOWLEDGE/SKILLS/ABILITIES** + Collaborate with Actuarial staff to calculate risk adjustment payment… more
- UCLA Health (Los Angeles, CA)
- Description As the Business Data Analyst for our Medicare Advantage Risk Adjustment team, you will be responsible for producing accurate and insightful ... department measurements used in both internal and external reporting. You will: + Ensure data quality and accuracy through rigorous assurance checks. + Develop and maintain reports, from ad hoc requests to scheduled production reports. + Write clear… more
- Centene Corporation (Providence, RI)
- …healthcare to improve outcomes, advance quality, and promote equity. The Analyst , Value-Based Payment Initiatives (VBP) will support the expansion and performance ... of Medicare -focused VBP arrangements across New York, including ...terms, and generating insights to guide strategic decision-making. The Analyst will work closely with the VBP Manager, Director,… more
- Centene Corporation (Tallahassee, FL)
- …for assigned function. This role will focus on data mapping for Medicare provider directories. + Support business initiatives through data analysis, identification ... + Perform data mapping and validation for large datasets related to Medicare provider directories + Support user acceptance testing (UAT) and troubleshoot issues… more
- Blue Cross Blue Shield of Massachusetts (Boston, MA)
- …exposure to all areas of BCBSMA, with a focus on senior product strategy and Medicare Markets. This candidate must be a creative thinker with the ability to drive ... collaboratively with both technical and non-technical staff including Underwriting, Medicare Product Development, Provider Contracting, Sales, and others across the… more
- University of Miami (Coral Gables, FL)
- …work at the University of Miami. CORE JOB SUMMARY The Contracts and Grants Analyst 1 ( Medicare Billing Coding & Financial) works independently to review ... including agreements and proposals, as required for development of Medicare Coverage Analysis (MCA), facilitating research billing, financial compliance and… 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 ... requirements are understood and implemented consistent with the Business Data Analyst 's vision + perform testing, design and delivery requirements + work… more
- TEKsystems (Brookfield, WI)
- …Performs other duties and responsibilities as assigned. Skills Claims processing, Claims Analyst , Medicare , CPT coding, ICD9, medical claims processing, Medicaid ... Top Skills Details Claims processing,Claims Analyst , Medicare ,CPT coding,ICD9,medical claims processing Additional Skills & Qualifications MUST: - High school… more
- Robert Half Finance & Accounting (Eatontown, NJ)
- …Eatontown and offers a hybrid schedule, has an opportunity for a Director Medicare /Medicaid Reimbursement. + The Director will have advanced level of knowledge of ... not listed above. + Planning, preparing and reviewing of the annual Medicare /Medicaid cost reports filings. In partnership with the Vice President of Corporate… more
- OhioHealth (Columbus, OH)
- …Description Summary:** This position is responsible for preparing and reviewing the Medicare and Medicaid cost reports for all OhioHealth entities. * This position ... will be responsible for ensuring the appropriate governmental ( Medicare and Medicaid) reimbursement is received for OhioHealth. * This position is primarily… more
- Commonwealth Care Alliance (Boston, MA)
- …TPA Management and Claims Compliance, Healthcare Medical Claims Coding Sr. Analyst will be responsible for developing prospective claims auditing and clinical ... This role will ensure that the applicable edits are compliant with applicable Medicare and Massachusetts Medicaid regulations. The role will also be responsible for… more