- Molina Healthcare (Bowling Green, 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
- Amazon (Nashville, TN)
- …The Program, Project, Product, and Vendor Management Team within Amazon's Logistics Claims Management and Operations group is seeking a motivated and experienced ... Senior Risk Manager. The ideal candidate will be familiar with insurance and claims programs, and insurance policies, have a history of success in procurement,… more
- Canon USA & Affiliates (Nashville, TN)
- **Mgr Medical Affairs - Clinical Development Sr - HIT - req1494** **OVERVIEW** Works independently and as part of a dynamic and fast-paced team of clinical and ... and review of collaterals for clinical accuracy and adherence to clinical claims . Effectively interacts with multiple teams including R&D, global and local business,… more
- Sumitomo Pharma (Nashville, TN)
- …computer systems . + Identifies and resolves discrepancies in submitted data invoices to ensure legitimacy of contract discounts. + Ensures detailed accuracy ... highly motivated, and experienced individual for the position of Sr . Manager, Medicaid Contract Administration. This position is responsible...of correct data input into company systems . + Maintains… more
- Evolent (Nashville, TN)
- …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
- Robert Half Finance & Accounting (Nashville, TN)
- … data such as provider billing information, Medicare reimbursement schedules, claims data , and electronic medical records. * Collaborate with Practice ... Description We are looking for a Sr . Revenue Analyst to join our team in...in a fast-paced environment. * Familiarity with accounting software systems , CRM tools, and data mining techniques.… more
- Evolent (Nashville, TN)
- …data using industry-standard metrics. + Process and validate raw unadjudicated claims data . **Qualifications Required and Preferred:** + Bachelor's degree, ... Familiarity with value-based care and utilization management is preferred + Understanding of data systems and the critical thinking skills to solve new problems… more
- Evolent (Nashville, TN)
- …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 (Bowling Green, 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
- Evolent (Nashville, TN)
- …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
- HNTB (Nashville, TN)
- …+ Creates complex cost models for cost estimating elements. Prepares claims analysis and estimates. + Performs parametric order-of-magnitude estimating by ... costs for labor, material and equipment using pricing schedules and historical data . + Develops duration estimates of specific construction activities based on… more
- Molina Healthcare (Bowling Green, KY)
- …Multiple data systems and models + Complex database and data management responsibilities + Claims processing background + Configuration background To all ... **Job Summary** Performs research and analysis of complex healthcare claims data , pharmacy data , and...and ancillary providers. + Implement and use software and systems to support the department's goals. + Strong knowledge… more
- Elevance Health (Nashville, TN)
- …rules. **Preferred Skills, Capabilities, and Experience:** + Experience working with encounter data systems within a healthcare payer or RCM organization and ... **Clinical Documentation and Claims Integrity Director** **Location:** Alternate locations may be...to ensure high quality encounter submissions. + Liaises with senior CareBridge and Elevance Health leadership across Product, Analytics,… more
- HCA Healthcare (Nashville, TN)
- …to update monthly reporting scorecard for performance guarantees. + Provide premium, claims , and administrative fee data to actuarial consultants to assist ... Do you want to join an organization that invests in you as a Senior Benefits Financial Analyst? At HCA Healthcare, you come first. HCA Healthcare has committed… more
- Highmark Health (Nashville, TN)
- …BE A US CITIZEN This position serves as a key liaison between Claims Operations, Customer Service, Regulatory Affairs, IT, Legal and other departments, proactively ... of applications he/she supports, how users use the application, and what other systems integrate with the application. Understands how work is being conducted, and… more
- Molina Healthcare (Bowling Green, KY)
- …Risk Adjustment Actuarial team. Responsibilities include research, analysis and modeling of complex healthcare claims data , pharmacy data , lab data , and ... **JOB DESCRIPTION** **Job Summary** This Sr . Analyst, Healthcare Analytics role will be responsible...I or Financial/Accounting Analyst I experience desired + Multiple data systems and models + Data… more
- Molina Healthcare (Bowling Green, KY)
- … systems to support executive decision-making + Mine and manage information from large data sources. + Analyze claims and other data sources to identify ... **JOB DESCRIPTION** **Job Summary** The Senior Analyst, Medical Economics provides support and consultation...evaluate the impact of provider reimbursement changes + Provide data driven analytics to Finance, Claims , Medical… more
- Otsuka America Pharmaceutical Inc. (Nashville, TN)
- …Operational Support will be responsible for managing and enhancing platform integrations across data systems , Salesforce Health Cloud and other CRM systems , ... and related CRM system integrations with internal and external systems , data platforms, and analytics solutions. +...you will be reimbursed, this is not Otsuka. These claims are fraudulent and you are strongly advised to… more
- Elevance Health (Nashville, TN)
- … data mining, entity review, law enforcement referral, and use of proprietary data and claim systems for review of facility, professional and pharmacy ... **Investigator Senior ** _Hybrid 1: This role requires associates to...to recover corporate and client funds paid on fraudulent claims . **How you will make an impact:** + Claim… more
- Elevance Health (Nashville, TN)
- … data mining, entity review, law enforcement referral, and use of proprietary data and claim systems for review of facility, professional and pharmacy ... **Investigator Senior ** **Supports the Payment Integrity line of business**...to recover corporate and client funds paid on fraudulent claims . Health insurance experience required with understanding of health… more