- Molina Healthcare (Milwaukee, WI)
- …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 (Milwaukee, WI)
- …Maintains critical provider information on all claims and provider databases. Synchronizes data among multiple claims systems and application of business ... rules as they apply to each database. Validate data to be housed on provider databases and ensure...and best practices while suggesting improvement processes to ensure systems are working more efficiently and improve quality. +… more
- Molina Healthcare (Milwaukee, WI)
- … 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
- Elevance Health (Waukesha, WI)
- **Business Consultant Senior - Commercial Claims Data Mining** **Hybrid 1:** This role requires associates to be in-office 1-2 days per week, fostering ... and adaptable workplace. Alternate locations may be considered. The **BUSINESS CONSULTANT SENIOR ** is responsible for translating the most highly complex and varied… more
- Molina Healthcare (Milwaukee, WI)
- … 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
- Elevance Health (Waukesha, WI)
- … 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
- Ascension Health (Mequon, WI)
- …practice review, governance, credentialing, privileging, peer review, medical information systems , and telemedicine opportunities. + Prioritizes and develop clinical ... goals. + Partner with the Chief Medical Informatics Officer to ensure that data and metrics are accurate, current, well-defined and relevant. + If the organization… more