- Cognizant (Columbus, OH)
- About the role As a ** Quality Analyst with Healthcare - Claims & Membership experience** . You will make an impact by designing and executing end-to-end ... test strategies that ensure the quality and reliability of healthcare claims and membership applications. You will be a valued member of the Quality … more
- Molina Healthcare (Columbus, OH)
- …and work PST hours. **Job Summary** Performs research and analysis of complex healthcare claims data, pharmacy data, and lab data regarding network utilization ... and cost containment information. Evaluates, writes, and presents healthcare utilization and cost containment reports and makes recommendations based on relevant… more
- Molina Healthcare (Columbus, OH)
- **JOB DESCRIPTION** **Job Summary** Performs research and analysis of complex healthcare claims data, pharmacy data, and lab data regarding network utilization ... and cost containment information. Evaluates, writes, and presents healthcare utilization and cost containment reports and makes recommendations based on relevant… more
- Molina Healthcare (Columbus, OH)
- …Microsoft Azure, AWS or Hadoop. * 3-5 Years of experience with predictive modeling in healthcare quality data. * 5+ Years of experience in Analysis related to ... **Job Summary** The Lead Analyst , Quality Analytics and Performance Improvement...plan reports related to managed care data like Medical Claims , Pharmacy, Lab and HEDIS rates * Assists and… more
- Molina Healthcare (Columbus, OH)
- …Microsoft Azure, AWS or Hadoop. + 1-3 Years of experience with predictive modeling in healthcare quality data. + 1-3 Years of experience in Analysis related to ... **Job Description** **Job Summary** The Analyst , Quality Analytics and Performance Improvement...Claims , Pharmacy, Lab and HEDIS rates. + Assist Quality department with HEDIS measure deep dive to support… more
- Molina Healthcare (Columbus, OH)
- **JOB DESCRIPTION** **Job Summary** The Analyst , Risk and Quality Reporting role supports Molina's Risk and Quality Health Plan team. This position designs ... on how to use reports related to Risk and Quality /HEDIS for Medicaid, Marketplace and Medicare/MMP. **Job Duties** +...plan reports related to managed care data like Medical Claims , Pharmacy, Lab and HEDIS rates + Assists and… more
- Evolent (Columbus, OH)
- …**What You Will Be Doing:** + **Data Analytics & Insights** : Analyze healthcare claims and authorization data to identify cost drivers, utilization trends, ... working seamlessly with diverse teams and stakeholders. + Familiarity with healthcare claims , reimbursement methodologies, and cost/utilization KPIs, including… more
- Molina Healthcare (Columbus, OH)
- …proficiency in SQL for large dataset analysis and transformation, specifically in processing healthcare claims data and supporting managed care reporting needs + ... solutions. * Write advanced SQL queries to extract, validate, and analyze healthcare data, including claims , authorization, pharmacy, and lab datasets. *… more
- Molina Healthcare (Columbus, OH)
- **Job Description** **Job Summary** The Lead Analyst , Reimbursement is responsible for administering complex provider reimbursement methodologies timely and ... existing lines of business and expansion into new states. The Lead Analyst , Reimbursement will be primarily responsible for implementation, maintenance, and support… more
- Molina Healthcare (Columbus, OH)
- …accurate and timely implementation and maintenance of critical information on claims databases. Maintains critical information on claims databases. Synchronizes ... improvement processes to ensure systems are working more efficiently and improve quality . + Assists in planning and coordination of application upgrades and… more
- Molina Healthcare (Columbus, OH)
- …for accurate and timely maintenance of critical provider information on all claims and provider databases. Maintains critical provider information on all claims ... management and credentialing. **KNOWLEDGE/SKILLS/ABILITIES** + Generates data to support continuous quality of provider data and developing SOPs and/or BRDs. +… more
- Prime Therapeutics (Columbus, OH)
- …to determine work assignments within project + Educate and advance business systems analyst practice within the Claims IT team and across the organization ... passion and drives every decision we make. **Job Posting Title** Sr. AI Business Analyst - Remote **Job Description** **Are you a Business Systems Analyst with… more
- Molina Healthcare (Columbus, OH)
- …for accurate and timely maintenance of critical provider information on all claims and provider databases. Maintains critical provider information on all claims ... and credentialing. **KNOWLEDGE/SKILLS/ABILITIES** + Audits loaded provider records for quality and financial accuracy and provides documented feedback. + Assists… more
- Prime Therapeutics (Columbus, OH)
- …data consolidation and modeling + PBM experience or experience working with medical claims , pharmacy claims , healthcare and/or benefits data + Experience ... and drives every decision we make. **Job Posting Title** Data and Reporting Analyst Assoc- REMOTE **Job Description** The Associate Data & Reporting Analyst … more
- Highmark Health (Columbus, OH)
- …BE A US CITIZEN This position serves as a key liaison between Claims Operations, Customer Service, Regulatory Affairs, IT, Legal and other departments, proactively ... identifying, assessing, and mitigating compliance risks. The Analyst will monitor regulatory changes, interpret their impact on operational processes, and implement… more
- Prime Therapeutics (Columbus, OH)
- …and drives every decision we make. **Job Posting Title** Sr. Compliance Analyst - Remote **Job Description** The Regulatory Inquiry & Complaints Senior Compliance ... Analyst assists in the implementation of Prime's compliance programs,...stakeholders to research and resolve regulatory inquiries/complaints related to claims , contracting and pharmacy reimbursement. Works directly with business… more
- OhioHealth (Columbus, OH)
- …various data sources including electronic medical record, decision support, clinical quality , clinical registries, and claims databases and understands ... in-person meeting per month in Columbus, Ohio. The Intermediate Informatics Data Analyst will support OhioHealth Pharmacy Services by analyzing and managing … more
- Evolent (Columbus, OH)
- …Codes, CPT Codes, RVUs, bundled payments, etc. + Working knowledge of healthcare claims ; specifically, differences between institutional vs professional billing ... and estimate Evolent's ability to reduce costs and improve quality . + Develop models to quantify and articulate value...health, biology) + 1+ years of professional experience in claims -based healthcare analytics with a payer, provider,… more
- Highmark Health (Columbus, OH)
- …Developers, and other team members to capture capability needs and drive quality business solutions. Create and maintain deliverables such as business vision, ... years in a relevant operational area (eg customer service, claims , enrollment and billing, etc.) to include 1 -...Insurance Industry + 1 - 3 years in the Healthcare Industry + 1 - 3 years in Lean/Six… more
- Prime Therapeutics (Columbus, OH)
- …information from research sources including the internet, trade publications, periodicals, analyst presentations, SEC filings, etc. + Support development of analytic ... 5 years of work experience in strategy, research or healthcare + Must be eligible to work in the...simultaneously **Preferred Qualifications** + Experience with large sets of claims data + In-depth knowledge of PBM industry +… more