- Molina Healthcare (Covington, KY)
- …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
- Molina Healthcare (Covington, KY)
- … 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
- Molina Healthcare (Covington, KY)
- …Multiple data systems and models + Complex database and data management responsibilities + Claims processing background + Configuration background To all ... **Job Summary** Performs research and analysis of complex healthcare claims data , pharmacy data , and...and ancillary providers. + Implement and use software and systems to support the department's goals. + Strong knowledge… more
- Elevance Health (Mason, OH)
- …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
- Molina Healthcare (Covington, KY)
- …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 (Covington, KY)
- … 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
- Elevance Health (Mason, OH)
- … 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
- Molina Healthcare (Covington, KY)
- …that internal teams and delegated vendors must follow, and you keep complaint data synchronized across appeals & grievances, enrollment, claims , pharmacy, and ... gains, audit readiness, and measurable member-experience improvements. You'll begin as a senior individual contributor with the charter to build a focused CTM… more