- Humana (Frankfort, KY)
- …our caring community and help us put health first** The Medicaid (PPS) Provider Hospital Reimbursement Analyst also known as a Senior Business ... the Pricer Business and System Support team responsible for administering complex Medicaid provider reimbursement methodologies. The associate will support… more
- Humana (Frankfort, KY)
- …part of our caring community and help us put health first** The Sr. Medicare (PPS) Provider Hospital Reimbursement Analyst will be an integral part of the ... of the team as it expands to accommodate the increased responsibilities. The Provider Hospital Reimbursement Analyst r will be primarily responsible… more
- Humana (Frankfort, KY)
- … Provider Contracting Professional 2 initiates, negotiates, and executes physician, hospital , and/or other provider contracts and agreements for an ... years of experience in negotiating managed care contracts with physician specialty, hospital and/or other provider contracts. + Proficiency in analyzing,… more
- Molina Healthcare (Lexington, KY)
- …when providers have issues or complaints (eg claims and encounter data, eligibility, reimbursement , and provider website). * Serves as a resource to support ... government-sponsored health plans. * Experience with various managed health care provider compensation methodologies, primarily across Medicaid and Medicare… more
- Molina Healthcare (Lexington, KY)
- …subject matter expert on developing financial models to evaluate the impact of provider reimbursement changes * Provides data driven analytics to finance, ... (UB04/1500 form). * Demonstrated understanding of key managed care concepts and provider reimbursement principles such as risk adjustment, capitation, FFS… more
- Molina Healthcare (Lexington, KY)
- …and/or functional requirements related to but not limited to coverage, reimbursement , and processing functions to support systems solutions development and ... **JOB DUTIES** + Develops and maintains requirement documents related to coverage, reimbursement and other applicable system changes in areas to ensure alignment to… more
- Humana (Frankfort, KY)
- …coding auditor to review inpatient hospital claims for proper reimbursement , handle provider disputes in a result-oriented and metrics-driven environment. ... Coding Auditor contributes to overall cost reduction, by increasing the accuracy of provider contract payments in our payer systems, and by ensuring correct claims… more
- Molina Healthcare (Lexington, KY)
- …modeling current and future contract rate proposals. * Research, analyze, and consult Medicaid and Medicare reimbursement methodologies, evaluate the impact of ... Business Intelligence tools (Medinsight, PowerBI), and Executive Dashboard. * Generate hospital performance analytics tools on a quarterly basis; develop reports on… more
- Molina Healthcare (Lexington, KY)
- …modeling current and future contract rate proposals. + Research, analyze, and consult Medicaid and Medicare reimbursement methodologies, evaluate the impact of ... Business Intelligence tools (Medinsight, PowerBI), and Executive Dashboard. + Generate hospital performance analytics tools on a quarterly basis; develop reports on… more
- Molina Healthcare (Lexington, KY)
- …(UB04/1500 form). * Advanced understanding of key managed care concepts and provider reimbursement principles such as risk adjustment, capitation, FFS ... from functional areas such as finance, health care services and provider contracting to translate analytic observations into meaningful clinical/operational actions… more