- Elevance Health (Louisville, KY)
- ** Medical Claims Data Integrity Consultant** **Location:** Atlanta, GA; Norfolk, VA; Indianapolis, IN; Chicago, IL; Louisville, KY (preferred). This role ... position is not eligible for current or future visa sponsorship._ The ** Medical Claims Data Integrity Consultant** (Business Information Developer… more
- Cognizant (Frankfort, KY)
- …established quality assurance instruments and standards + Verifying if the processed claims have all data updated accordance with accepted coverage guidelines, ... ** Claims Auditor** (remote) This is a remote position...+ High Attention to detail + High Level of Integrity and Ethical Behavior **Salary and Other Compensation:** Applications… more
- Prysmian (Highland Heights, KY)
- …accounting support to suppliers. + Responsible for accuracy, timelines, and the general integrity of the accounting data (including suppliers master data ) ... of optical fibers, copper cables and connectivity for voice, video and data transmission for the telecommunication sector._ _We are 30,000 employees, across 50+… more
- Waystar (Louisville, KY)
- …Provided leadership on a team that designed, built, or used RCM Revenue Integrity products + Ability to interpret regulatory guidelines from CMS, Tricare, and ... Waystar's healthcare payments platform combines innovative, cloud-based technology, robust data , and unparalleled client support to streamline workflows and improve… more
- Elevance Health (Louisville, KY)
- **Investigator II - Payment Integrity SIU** **Location:** This role requires associates to be in-office 1 - 2 days per week, fostering collaboration and ... employment, unless an accommodation is granted as required by law._ **Carelon Payment Integrity ** is a proud member of the Elevance Health family of companies,… more
- Elevance Health (Louisville, KY)
- …fraud and abuse prevention and control. + Review and conducts analysis of claims and medical records prior to payment. Researches new healthcare-related ... **Clinical Fraud Investigator II - Registered Nurse and CPC - Calrelon Payment Integrity SIU** **Location:** This role requires associates to be in-office 1 - 2 days… more
- Elevance Health (Louisville, KY)
- …How you will make an impact: + Collects, researches, and validates bills and claims data against relevant guidelines + Assists in preparation of statistical and ... **Investigator Assistant - Payment Integrity SIU** **Location:** This role requires associates to..., is determined to recover, eliminate and prevent unnecessary medical -expense spending. The **Investigator Assistant** will be responsible for… more
- Elevance Health (Louisville, KY)
- …make an impact:** + Using appropriate system tools and databases for analysis of data and review of professional and facility claims to detect fraudulent, ... **Investigator I - Payment Integrity SIU** **Location:** This role requires associates to..., is determined to recover, eliminate and prevent unnecessary medical -expense spending. The **Investigator I** will be responsible for… more
- Humana (Frankfort, KY)
- …and reporting. Identify cost drivers, utilization patterns, and anomalies in Medicaid medical claims data . Maintain dashboards to communicate key ... trends to stakeholders. The Actuary, Analytics/Forecasting ensures data integrity by developing and executing necessary processes and controls around the flow of… more
- Otsuka America Pharmaceutical Inc. (Frankfort, KY)
- …Commercial third-party data assets, including Xponent Plantrak, DDD, HCOS, Claims Data , Specialty pharma, omnichannel data , SalesForce/Veeva ... **Job Summary** The Associate Director (AD), Commercial Data Management (CDM) within Data Enablement (DE) for Business Analysis (BA) is accountable for… more
- Norstella (Frankfort, KY)
- …querying and analyzing a wide range of healthcare data sources, including claims , lab results, electronic medical records (EMR), and other real-world data ... Norstella's newest service offerings leveraging Norstella's unified Real World Data asset, a combination of claims , lab,...data into structured formats suitable for analysis, ensuring data quality and integrity throughout the process… more
- Molina Healthcare (Covington, KY)
- …criteria for medical necessity. + Participates in and maintains the integrity of the appeals process, both internally and externally. Responsible for the ... claims and appeals and resolves grievances related to medical quality of care. + Attends or chairs committees...needed. + Fosters Clinical Practice Guideline implementation and evidence-based medical practice. + Utilizes IT and data … more
- Norstella (Frankfort, KY)
- …the demand for Norstella's newest service offerings leveraging Norstella's unified Real World Data asset, NorstellaLinQ, a combination of claims , lab, SDOH and ... databases, ensuring data accuracy and quality. *Perform in-depth analyses on healthcare data sources, including claims , lab, EMR/EHR, and SDOH data , to… more
- Otsuka America Pharmaceutical Inc. (Frankfort, KY)
- …lead the R&D audit program, engage with regulatory authorities, and maintain clinical data integrity . The leader will be responsible for providing a compelling ... authorities, facilitating Clinical and PV inspections and addressing any findings. + ** Data Integrity :** Ensure the accuracy, consistency, and reliability of… more
- CVS Health (KY)
- …perform root cause analysis, and recommend improvements to enhance reporting accuracy and data integrity . + Stay informed about changes in Medicaid policy, ... investigations of potential fraud, waste, and abuse in Medicaid claims and provider activity. + Prepare timely and accurate...findings to non-technical audiences. + 2+ years experience interpreting medical claim data + Advanced experience in… more
- Elevance Health (Louisville, KY)
- **Investigator Senior** **Supports the Payment Integrity line of business** **Hybrid 1** : This role requires associates to be in-office **1-2** days per week, ... employment, unless an accommodation is granted as required by law._ Carelon Payment Integrity is a proud member of the Elevance Health family of companies, Carelon… more
- CDM Smith (Bowling Green, KY)
- …claims . This role is critical in evaluating and analyzing financial data related to disaster-related claims , including property damage, business interruption, ... investigations to identify discrepancies, detect potential fraud, and ensure the integrity and fairness of claim settlements. By applying advanced accounting,… more
- Centene Corporation (Frankfort, KY)
- … claim analysis, or fraud investigation experience. Knowledge of Microsoft Applications medical coding, claims processing, and data mining preferred. ... Assist in monitoring business processes and systems to assure integrity and compliance in billing and claims ...to identify potential waste, abuse and fraud + Perform data mining and analysis to detect aberrancies and outliers… more
- Otsuka America Pharmaceutical Inc. (Frankfort, KY)
- …of clinical medicine and/or clinical pharmacology and associated disciplines (eg biostatistics, data management, medical writing). + An advanced understanding of ... drug development programs, including: + Understanding pharmacology of drugs and unmet medical needs. + Formulating a rationale to develop the drug in accordance… more
- Walmart (Paducah, KY)
- …Summary ** Completes work assignments and priorities by using policies, data , and resources; collaborating with managers, co-workers, customers, and other business ... and feedback. Complies with company policies, procedures, and standards of ethics and integrity by implementing related action plans; using the Open Door Policy; and… more