or health insurance company) preferred Experience working with healthcare data including but not limited to claims, testing...Summary: Develop data-driven analysis for decision making on how EmblemHealth purchases, manages, and influences the...
latest benefits and innovations in medical technology, research and family-friendly design. As the largest pediatric provider... to identify and rectify denial issues resulting in timely reimbursement and final disposition of claims. Verifies accuracy...
offerings Medical/dental/vision insurance and voluntary insurance options Health Savings Account funding 401k matching... clients’ data to recommend appropriate plans and proposals for the client. Typical functions include but are not limited...
is responsible for prompt and accurate review of claims in the research billing work queue. Responsible for ensuring that patient... and issues posed by study team members. May include working with medical records, following HIPPA guidelines...
for service line growth initiatives using various data sources including inpatient discharges, claims, demographics and mapping... growth opportunities, risks, and trends using data analytic capabilities and provides actionable recommendations. Education...
experience in healthcare operations, medical billing and coding Good communication skills to interact with internal clients... and claims management and the latest business intelligence reporting dashboards for clients in 40 states. Since our first day...
and Medical Directors on identified audit opportunities. Communicates results effectively with senior team members.... Utilize internal and external tools to evaluate, document, and validate new ideas, claims, and concept effectiveness...
, the Case Manager performs clinical review of medical specialty pharmacy services, coordinates transition of care, product... rate negotiations, and accurately calculates medical cost savings. Case Managers performs case management evaluation...
, the Case Manager performs clinical review of medical specialty pharmacy services, coordinates transition of care, product... rate negotiations, and accurately calculates medical cost savings. Case Managers performs case management evaluation...
configuration of business requirement Analyze larger sets claims data to evaluate patterns of billing as it relates to benefit..., including proficiency with ICD-10, CPT, HCPCS, revenue codes, and medical terminology 2+ years of experience in data analysis...
insurance claims data; ▪ Quantifying and prioritizing risk exposure and evaluating whether insurance premiums paid... of UPG insurance policies for real property and other company assets, including business and medical equipment...
? Microsoft Word: Intermediate Microsoft Excel: Intermediate Knowledge and experience using data retrieval and analysis... Systems, System Process Flows, Technical Use Case Preparation, Presentation Skills, Technical Requirements Definition, Data...
? Microsoft Word: Intermediate Microsoft Excel: Intermediate Knowledge and experience using data retrieval and analysis... Systems, System Process Flows, Technical Use Case Preparation, Presentation Skills, Technical Requirements Definition, Data...
analysis, and data-mining, to ensure that accurate claims/encounter data. Develop mathematical modeling techniques... enrollment and claims data for patterns and trends to identify opportunity to improve documentation and coding. Monthly P...
Overview Conducts analysis of claims and payment data across health plans in support of ensuring payment integrity...'s contracted rates. Reconciles and validates underlying analytic data claims, and utilization management systems. Tests the...
-emergency medical transportation sectors. We are looking for Fleet Telematics Administrator to help support our growing fleet... programs Collect, process, and distribute relevant data about the fleet department and telematics Manage the device RMA...
reviews based on clinical determination. You will review claims for medical necessity and to meet the criteria for the coding... such as Medicare and Medi-cal Conducts clinical review of claims for medical necessity, coding accuracy, medical policy compliance...
; identify potential payor enrollment issues; and monitor and act upon claims denials. 6. Directs the payment of Medical... in conjunction with Finance and Provider Practice Leadership. 9. Conduct analytical research of historical data as well...
lines, agent, or book of business. Evaluate profit factors and conduct analysis of performance data to provides product.... Work with partners in pricing/actuarial or claims to ensure product compliance and financial viability. Prepare contract...
of syndicated pharmaceutical data sources, including formulary data sources and claims data sources; hands-on experience working..., and commercialization of novel medicines to meet serious unmet medical needs in oncology and inflammation and autoimmunity. Incyte...