- Commonwealth Care Alliance (Boston, MA)
- 011250 CCA-Claims **Position Summary:** Reporting to the Director, Claims Operations and Quality Assurance , the Claims Sr. Analyst plays a critical role in ... and timely reimbursements within the scope of MassHealth and Medicare Advantage programs. Under the direction of the Director...the direction of the Director of Claims Operations and Quality Assurance , this role is responsible for… more
- Robert Half Accountemps (Los Angeles, CA)
- Description A National Healthcare Organization is seeking a knowledgeable and detail-oriented Quality Assurance /Risk Analyst to join its Los Angeles Team. ... Audit Management, Medi-Cal, Excel Formulas, Health Care Audits - Medicare - Medicaid, Medical Insurance, Risk Management, QA -... - Medicaid, Medical Insurance, Risk Management, QA - Quality Assurance Robert Half is the world's… more
- Providence (Renton, WA)
- …Senior Quality Analyst assists the Claims leaders in managing a quality assurance program to ensure compliance with laws and regulations pertaining to ... Analyst is also responsible for maintaining a claims quality assurance program, management of projects and...aides and technical support for caregivers regarding Centers for Medicare and Medicaid Services (CMS) Medicare Secondary… more
- State of Colorado (Denver, CO)
- …responsible for identifying operational improvements and directing specifics for policy improvement Quality Assurance Auditor/ Analyst + Rviews client files ... Quality Assurance Policy Specialist/Auditor/Health Professional II...Background check: CBI name check, ICON Colorado court database, Medicare fraud database, Reference checks, Professional License verification (licensure… more
- LA Care Health Plan (Los Angeles, CA)
- …care measures such as those used by National Committee for Quality Assurance (NCQA), HEDIS, Centers for Medicare and Medicaid Services (CMS), and State. ... are used for internal and external reporting, the tasks including data quality assurance , process programming, specification documentation and report developing.… more
- New York State Civil Service (NY)
- …supports, and advocacy for people with developmental disabilities. Within the Department of Quality Assurance , the Senior Administrative Analyst will serve ... People With Developmental Disabilities, Office for Title Senior Administrative Analyst Occupational Category Administrative or General Management Salary Grade 18… more
- RWJBarnabas Health (Oceanport, NJ)
- …of protocol submission to the end of the study. 7. Assists management with Quality Assurance audits of research billing. 8. Works with Clinical Trial Educator ... Charge Capture Analyst -Patient Accounts, Remote for NJ, PA or...research charges are collected and posted in accordance with Medicare s Clinical Trial Policy, federal regulations and pharmaceutical/third… more
- Prime Therapeutics (Eagan, MN)
- …requestors to resolve questions regarding requested software changes, and participate with Quality Assurance and UAT resources to review related test cases ... and drives every decision we make. **Job Posting Title** Sr. Business Systems Analyst **Job Description** The Sr. Business Systems Analyst (BSA) is responsible… more
- Houston Methodist (Houston, TX)
- …risk and identify and capture potential revenue opportunities. This position performs quality assurance , detailed claims analysis and medical record reviews of ... claims are being billed to patients and third-party payers. Performs quality assurance . **GROWTH/INNOVATION ESSENTIAL FUNCTIONS** + Proactively stays up-to-date… more
- Zelis (Plano, TX)
- …to determine and document business requirements. + Lead pricer maintenance, quality assurance activities, audits, troubleshooting, and defect corrections. + ... that shape who you are. Position Overview The Sr. Medicaid Reimbursement Regulatory Analyst will collaborate with the Zelis Regulatory Pricer Product team to further… more
- Convey Health Solutions (Chicago, IL)
- …laws, rules and regulations affecting Pareto. + Responsible for participating in quality assurance , compliance and in-service and continuing education activities ... Job Description SUMMARY The Data Analyst will be responsible for utilizing technical and...procedures. + Familiarity with healthcare payer/provider claims, clinical, or quality data. + Risk Adjustment experience is preferred. OTHER… more
- Motion Recruitment Partners (Durham, NC)
- …Medicaid Services (CMS), ERISA, etc.) accreditation agency standards (National Committee for Quality Assurance - NCQA), ASO group performance guarantees and ... Appeals Analyst Durham, North Carolina **100% Remote** Contract $20/hr...for all decisions regarding clinical appeals/grievances. + Ensures timeliness, quality , and efficiency in all work to comply with… more
- Humana (Denver, CO)
- …Creating and executing comprehensive test plans + Ongoing Medicaid pricer maintenance, quality assurance , and compliance + Determining root causes driving issues ... put health first** The Medicaid (PPS) Provider Hospital Reimbursement Analyst also known as a Senior Business Intelligence Engineer...need it. These efforts are leading to a better quality of life for people with Medicare ,… more
- Fairview Health Services (Minneapolis, MN)
- …assigned including but not limited to: process improvement and trend analysis, quality assurance and research **Organization Expectations, as applicable:** + ... Health Plan Payers. As a member of the pharmacy team, the Contract Analyst manages and coordinates all financial information with third party plans to ensure… more
- Healthfirst (NY)
- …up, reimbursement methodology and core claims system changes. + Perform training and quality assurance on mass claim adjudications and automated data load ... updates to payment methodologies, fee schedules and claims editing policies from Medicare , Medicaid, and third-party sources. + Responsible for the overall success… more
- WellSpan Health (York, PA)
- …and changes to ensure 340B compliance. + Education - Develops proper 340B quality assurance training for employees as appropriate. - Provides proactive education ... as required. + Maintains established policies and procedures, objectives, quality assessment, safety, environmental and infection control standards. + Participates… more
- LA Care Health Plan (Los Angeles, CA)
- …Solution Center Business Analyst to track, trend, and analyze results of Quality Assurance (QA) scorecards for training and quality improvement. Perform ... Medicare and Medicaid Services(CMS), LACC - CalHers, and National Committee for Quality Assurance (NCQA) along with review and analysis of regulatory… more
- City and County of San Francisco (San Francisco, CA)
- …experience + Engaging staff and improving their experience + Participating in quality assurance activities Once submitted, applicant responses on the Required ... reapply. The Department of Public Health prioritizes equitable and inclusive access to quality healthcare for its community and values the importance of diversity in… more
- City and County of San Francisco (San Francisco, CA)
- …methods, and procedures within the specialty area; including but not limited to Quality Assurance activities; prepares or reviews detailed and complex medical ... reapply. The Department of Public Health prioritizes equitable and inclusive access to quality healthcare for its community and values the importance of diversity in… more
- City of New York (New York, NY)
- …the operation of the Office of Audit Services (OAS) and Office of Quality Assurance (OQA), Office of Accountability Strategies (OAS), Compliance and Contract ... Description APPLICANTS MUST BE PERMANENT IN THE ADMINISTRATIVE STAFF ANALYST CIVIL SERVICE TITLE OR IN A COMPARABLE TITLE...and acquire the analytical, data mining, data matching, data quality , and data sharing methods and/or tools that drive… more