- WelbeHealth (Phoenix, AZ)
- …Health Plan Services team helps ensure excellent care delivery for our participants, and the Claims Audit Analyst plays a pivotal role in ensuring timely and ... accurate pre-payment or denial of claims while meeting federal/state regulations, provider agreements terms, and/or company policies and procedures. **Essential Job… more
- WTW (Tempe, AZ)
- …**The Role** We are seeking an organized and detail-oriented Retirement Plan Compliance Analyst to join our team. As a compliance analyst you will ... with ERISA regulations and other applicable federal laws. Adhere to audit protocol to ensure accuracy of documentation. **Document Production/Management:** Adhere to… more
- Highmark Health (Phoenix, AZ)
- …and training materials specific to underwriting functions, ensuring clarity for audit and compliance. + Collaborate closely with underwriters to analyze existing ... 3 - 5 years of experience in a Business Analyst or Business Process Analyst role or...role or experience in a related operational area (eg claims , billing, customer service, etc.) **Preferred** + Experience in… more
- Molina Healthcare (Scottsdale, AZ)
- **Job Description** **Job Summary** The Analyst , Quality Analytics and Performance Improvement role will support Molina's Quality Analytics team. Designs and ... develops reporting solutions to assist HEDIS audit , rate tracking, and Identifying targeted Interventions and tracking...and reporting related to Managed care data like Medical Claims , Pharmacy, Lab and HEDIS rates. + Assist Quality… more
- RTX Corporation (Tucson, AZ)
- …a safer, more secure world. This position is for a Sr. Financial Analyst , FP&A, in the Raytheon Rates Organization. Responsibilities include creating, analyzing, and ... well as supporting forward pricing rate submissions and incurred cost claims . Additional duties include providing cross-functional training, performing ad hoc… more
- CVS Health (Scottsdale, AZ)
- …every day. This is a hybrid position. **Position Summary** As a Rebate Formulary Analyst - Manufacturer Rebates you will perform a critical role in the analysis of ... Support Services as they work with clients in the development of formularies; Rebate audit team as questions arise on audits by manufacturers and clients. + Adhering… more
- Banner Health (AZ)
- …information from a variety of sources. 2. Reviews medical records. Performs an audit of clinical documentation to ensure that clinical coding is accurate for proper ... to resolve issues and support appropriate reimbursement. Proficiency in claims software to address coding edits and claim denials...as a basis for development of coding education and audit plans. 6. Maintains a current knowledge in all… more
- Air National Guard Units (Phoenix, AZ)
- …as the Financial Management (FM) focal point for the Financial Improvement and Audit Readiness (FIAR) initiative, as well as, advise the Comptroller and Wing ... documents to ensure supporting documents are applicable and valid. Perform post- audit voucher review. Works closely with the financial management staff to… more
- Molina Healthcare (Chandler, AZ)
- …in Connecticut** **Job Summary** Performs research and analysis of complex healthcare claims data, pharmacy data, and lab data regarding network utilization and cost ... in response to approved change requests; retain old and new report design for audit trail purposes. + Analyze data sets and trends for anomalies, outliers, trend… more
- Molina Healthcare (Phoenix, AZ)
- …care or payer environment. + In-depth knowledge of medical and hospital claims processing, including CPT/HCPCS, ICD, and modifier usage. + Strong understanding of ... claim system configurations, payment policies, and audit processes. + Exceptional analytical, problem-solving, and documentation skills. + Ability to translate… more
- Highmark Health (Phoenix, AZ)
- …with a general understanding of data flows from various corporate systems (eg, claims , billing, lab, and Rx), to solve complex issues and problems. A comprehensive ... include but not limited to, review/editing of content submissions and best practices, audit reports, etc. The incumbent is expected to make major contributions to… more