- Molina Healthcare (Louisville, 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 (Louisville, 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
- BrightSpring Health Services (Louisville, KY)
- …focus on fulfilling the pharmaceutical needs of our long-term care and senior living clients. We offer a non-retail pharmacyenvironment. Our organization is inhigh ... career progression! Step Into a Rewarding Role as a Claims Analystwith PharMerica! The3rd Party Claims Analystis...+ Required: 1+ yrs experience with pharmacy or health data analysis + Required: 1+ yrs experience working in… more
- Elevance Health (Louisville, KY)
- ** Senior Test Lead - Pharmacy Benefit Manager (PBM)** **Location:** This role requires associates to be in-office 1 - 2 days per week, fostering collaboration and ... a strong, clinical-first lens to deliver member-centered, lasting pharmacy care. The ** Senior Test Lead (Business Change Manager Senior )** will be responsible… more
- BrightSpring Health Services (Louisville, KY)
- …institutional equivalent special needs plans populations. + Knowledge of health plan data domains and their relationships (member, provider, claims , network, ... Operational Leadership + Design, develop, refine and lead operational strategies, systems , and workflows across health plan domains to improve quality, outcomes,… more
- Waystar (Louisville, KY)
- …the leading Healthcare Revenue Cycle Management (RCM) technology company, is seeking a seasoned Senior Data Engineer to support and evolve our Data Licensing ... insights to customers. You will work with complex healthcare data from multiple source systems and ensure...accuracy and quality. **Preferred:** + Experience working with healthcare data and understanding RCM processes ( claims , billing,… more
- Elevance Health (Louisville, KY)
- … data mining, entity review, law enforcement referral, and use of proprietary data and claim systems for review of facility, professional and pharmacy ... healthcare fraud in order to recover corporate and client funds paid on fraudulent claims . **How you will make an impact:** + Claim reviews for appropriate coding,… more
- BrightSpring Health Services (Louisville, KY)
- …+ Update, validate and communicate impact of strategic operational changes to senior management and Company operations on a consistent basis. + KPI & ... other tools. + Prepare forecasting/recasting analysis & support: audit historic data , model current and future assumptions, coordinate and collaborate with… more