- Molina Healthcare (Santa Fe, NM)
- …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
- Evolent (Santa Fe, NM)
- …mission. Stay for the culture. **What You'll Be Doing:** Evolent Health is looking for a Sr . Product Owner within our Common Data portfolio to be a key member of ... a technical field or relevant related field + Understanding of healthcare data formats (eg, eligibility, claims , configuration, authorizations, clinical data… more
- Evolent (Santa Fe, NM)
- …Familiarity with value-based care and utilization management is preferred + Understanding of data systems and the critical thinking skills to solve new problems ... interactions fostering expertise and cooperation. + Extract, manage, and analyze claims and operational data using industry-standard metrics. **Qualifications… more
- Molina Healthcare (Santa Fe, NM)
- … 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
- Evolent (Santa Fe, NM)
- …skills + Microsoft Office experience (Excel, Visio) + Understanding of healthcare data formats (eg, eligibility, claims , configuration, authorizations, clinical ... You'll Be Doing:** Evolent Health is looking for a Senior Product Owner to be a key member of...key member of the Product team, focused on client data integrations. This individual will play a critical role… more
- Humana (Santa Fe, NM)
- …community and help us put health first** Humana's Gulf South Region is seeking a Senior Data and Reporting Professional that generates ad hoc reports and regular ... or data warehouse queries and scripts. The Senior Data and Reporting Professional: + Integrates...insurance industry or health care sector with authorization or claims data + Ability to see trends… more
- Cardinal Health (Santa Fe, NM)
- …and enhance the overall healthcare experience. We are seeking a highly motivated and experienced Senior Data Scientist to join our team as a thought leader and ... data to solve complex business problems on large data sets, integrating multiple systems . At Cardinal...Extensive knowledge of healthcare data , including clinical data , patient demographics, and claims data… more
- Datavant (Santa Fe, NM)
- …designing, developing, and maintaining robust data pipelines for healthcare data including prescriptions, medical claims , MAO4, patient demographics, and ... with the other engineering teams to troubleshoot issues with API's and data exchanges between multiple systems . **What You Need to Succeed** + 5+ years Data … more
- Otsuka America Pharmaceutical Inc. (Santa Fe, NM)
- **Position Summary** The Senior Manager of Field Technology will lead the design, optimization, and delivery of field sales reporting platforms and tools. This role ... in ensuring that our field teams have seamless access to accurate, actionable data to drive performance. The role focuses on managing field-facing technology … more
- Evolent (Santa Fe, NM)
- …SAS, SQL, or similar analytical software to analyze clinical authorization and healthcare claims data * Using analytical tools to integrate various data ... care data including medical, pharmacy and ancillary claims data , membership data , clinical...feasible given data limitations * Understanding of data systems and the critical thinking skills… more
- Highmark Health (Santa Fe, NM)
- …overall business targets or assigned volume of new applications or RFP's.Utilize various systems and tools to obtain necessary data and accurately complete and ... quotes and analyzes the structure of a contract for a group based on claims experience, characteristics of the employee groups, etc. The incumbent uses discretion of… more
- Otsuka America Pharmaceutical Inc. (Santa Fe, NM)
- …- Interacts effectively with internal/external functional business units to gather data and develop documentation required for on-time submissions. - Works closely ... (Word, Excel, PowerPoint, Outlook) and familiarity with electronic document management systems (EDMS). **Competencies** See OPDC Competencies Chart (Level X) **P**… more
- Otsuka America Pharmaceutical Inc. (Santa Fe, NM)
- …of the Quality Systems and Risks will be reported periodically to Senior Management through the Management Review process to ensure alignment with Company policy ... the R&D audit program, engage with regulatory authorities, and maintain clinical data integrity. The leader will be responsible for providing a compelling vision… more
- Otsuka America Pharmaceutical Inc. (Santa Fe, NM)
- …Content Enablement -this leader ensures that insights, content, tools, training, and systems are aligned to business priorities and delivered with excellence. This ... therapeutic-area specific Brand Analytics & Insights, Payer and Field Analytics, Data Enablement, and Forecasting. + Deliver timely, actionable insights and decision… more
- Highmark Health (Santa Fe, NM)
- …overall business targets/or assigned volume of new applications or RFP's.Utilizes various systems and tools to obtain necessary data and accurately complete ... quotes and analyzes the structure of a contract for a group based on claims experience, characteristics of the employee groups, etc. The incumbent develops and uses… more
- Highmark Health (Santa Fe, NM)
- …utilization and care management solutions, patient-focused digital products, and clinical data exchange capabilities, as well as outsourced technology and BPO ... competitive pricing strategies for our diverse portfolio SaaS, Platform, Modular, Data and AI-based healthcare technology products and services, covering the Payor… more