- Commonwealth Care Alliance (Boston, MA)
- …of the Sr . Director, TPA Management and Claims Compliance, Healthcare Medical Claims Coding Sr . Analyst will be responsible for developing ... prospective claims auditing and clinical coding and reimbursement edits and necessary coding ...**Essential Duties & Responsibilities:** + Develop enhanced, customized prospective claims auditing and clinical coding and reimbursement… more
- Healthfirst (NY)
- …AMB Surgery, DME, vaccination Ambulance fee schedules + Prior experience with multiple claims scrubbers to ensure coding guidelines are followed + Prior ... codes (ICD-10) represent patient services, treatments, copays, and coinsurance + Verify coding accuracy to support compliant billing and prevent claim denials and… more
- AdventHealth (Maitland, FL)
- …days at the office (Altamonte Springs, FL)** **The role you'll contribute:** A Senior Medical Economics analyst is responsible for analyzing and evaluating ... care contracts and proposals, analyze fee schedules, and determine contract compliance. The Senior Medical Economics analyst must have attention to detail and… more
- Philadelphia Insurance Companies (Bala Cynwyd, PA)
- …member of Ward's Top 50 and rated A++ by AM Best. We are looking for a Sr . Reporting Analyst I to join our team! Summary: Ensure accuracy and timeliness of ... all aspects of Verisk's Statistical Web Services applications. Well versed in ISO coding requirements and Strong understanding of ISO rating in multiple lines of… more
- Molina Healthcare (Columbus, OH)
- **JOB DESCRIPTION** **Job Summary** The Senior Analyst , Medical Economics provides support and consultation to the Clinical Center of Excellence, Health Plan, ... tools to monitor trend drivers and provide recommendations to senior leaders on UM and CM improvements. Responsible for...and manage information from large data sources + Analyze claims and other data sources to identify early signs… more
- Molina Healthcare (Columbus, OH)
- **JOB DESCRIPTION** **Job Summary** The Senior Analyst , Medical Economics provides support and consultation to the Health Plan and Finance team through analyzing ... creating tools to monitor trend drivers and provide recommendations to senior leaders for affordability opportunities. Responsible for conducting complex analyses of… more
- AIG (Parsippany, NJ)
- …we are reimagining the way we help customers to manage risk. Join us as a Senior Loss Sensitive Analyst to play your part in that transformation. It's an ... limited to completing security calculations, premium reconciliations, program adjustments, prep- coding , and other projects. + Compile and organize relevant coverage… more
- University of Texas Rio Grande Valley (Mcallen, TX)
- Position Information Posting NumberSRGV8219 Working TitleCOMPLIANCE CODING AND BILLING ANALYST Number of Vacancies1 LocationMcAllen, Texas DepartmentOffice of ... , and reimbursement processes. + Reviews, assesses and analyzes medical records, coding , billing, claims , reimbursements and workflow processes to ensure… more
- Mount Sinai Health System (New York, NY)
- …Facility and Ancillary Contracts across the Mount Sinai Health System. MSHP seeks a ** Senior Contract Manager Analyst ** will play a critical role in testing, ... within MSHP team + Opportunity to work directly with senior leaders from across the Mount Sinai Health System...the revenue cycle system. A strong background in contract coding , logic, and the ability to interpret contract terms… more
- AdventHealth (Maitland, FL)
- …- Hybrid - Altamonte Springs, FL** **The role you'll contribute:** The Senior Compliance Analyst applies technical, analytical, and problem-solving skills to ... sources of data to support executive decision-making regarding contract violations. The Senior Compliance Analyst will have expertise in Commercial and… more
- VNS Health (Manhattan, NY)
- …the success of our organization. We are looking for an ambitious and curious senior health economics analyst to join our team. Compensation Range:$93,400.00 - ... credits, and advancement opportunities What You Will Do The Senior Health Economics Analyst will join a...of our membership? "Our analysts are knowledgeable about medical claims data and the risk-adjustment models that determine our… more
- ChenMed (Miami, FL)
- …We're rapidly expanding and we need great people to join our team. The Senior Health Economics Analyst is responsible for identifying and delivering data-driven ... data-driven strategy recommendations in the Medicare Advantage and healthcare industry. This senior -level analyst position has the opportunity for impact and… more
- Cedars-Sinai (Beverly Hills, CA)
- …standard of patient care we strive for. **What will you be doing:** The Senior Financial Analyst is responsible for assisting with the development, design, ... and interpreting patient medical records using CPT and ICD10 coding systems. Technical understanding of Healthcare Data systems is...of study **Req ID** : 6681 **Working Title** : Senior Financial Analyst (Managed Care) - Hybrid… more
- Highmark Health (Columbus, OH)
- …a big impact for those we serve. This job performs highly complex benefit coding , new client and group installation, as well as set-up of network structures (eg ... non standard tiering) and pricing methods in a senior operational role. Translates complex group and client information into system configuration, including but not… more
- LogixHealth (Bedford, MA)
- …Ma; Onsite This Role: Perform day to day contract implementation duties. The Senior Contract Analyst is responsible for modeling possible contract seniors for ... revenue cycle management services, offering a complete range of solutions, including coding and claims management and the latest business intelligence reporting… more
- DriveTime (Tempe, AZ)
- …in the future are not eligible for hire at this time._** In long, our Senior Analyst , Strategic Analytics are responsible for: + Innovate on existing products ... which provides quality warranty and ancillary products, and a customer-friendly claims process. SilverRock offers a variety of ancillary products and administrative… more
- Surgery Care Affiliates (Chicago, IL)
- …team, they will. Responsibilities SCA Health is currently accepting applications for a Senior Analyst position on our innovative and fast-paced Payer Informatics ... that support key enterprise initiatives + Load, cleanse, and analyze externally-sourced claims data, combining with internal data sources to develop complex business… more
- UPMC (Pittsburgh, PA)
- …Care departments related to audit processes and results. The Clinical FWA Auditor/ Analyst utilizes claims analysis, document review and applies FWA detection ... Health Plan has an exciting opportunity for a Clinical Auditor/ Analyst position in the CCBH Fraud, Waste & Abuse...directly to a Manager, FWA, with oversight by the Senior Director and utilizes a variety of FWA investigative… more
- CVS Health (Baton Rouge, LA)
- …we do it all with heart, each and every day. Position Summary As a Senior Investigator you will conduct high level, complex investigations of known or suspected acts ... fraud schemes. + Investigates to prevent payment of fraudulent claims submitted to the Medicaid lines of business +...fraud and abuse matters. + Working knowledge of medical coding ; CPT, HCPCS, ICD10 + Proficiency in Microsoft Office… more
- CVS Health (Hartford, CT)
- …efforts of teammates and the communication with business partners in Medical Claims Management, Claim Operations, Finance, and our Medical Economics Unit to ... well as provider discounts to apply to billed large claims . **Required Qualifications** + Must have passed a minimum...verbal and written communication skills + SQL and VBA coding skills along with model building experience + Demonstrated… more