Jobs in Analyst

Key Requirements • Health Care experience • Workflow automation and integration between Care Management and Customer Contact Systems • Knowledge of Agile/waterfall Process Overview: Plan, develop, test and implement IT system solutions that improve business efficiency and productivity as well as support business strategies and goals. Identify and communicate business needs and translate business requirements…

Responsible for assisting and supporting the Group Operational Readiness team in the project coordination, establishment, and delivery of programs including but not limited to 2022 and 2023 ASC Contracting. Top 3 Required Skills/Experience – The most important must-have skills. Include: • Advanced Microsoft Skills in Word and Sharepoint, along with intermediate skills in Excel and…

Engagement Description – Responsible for leading the development and implementation of programs and strategies by identifying insights that enhance business decision making capabilities to ensure business readiness. This position will implement, monitor, and evaluate Care Management programs which includes measuring program performance, continuous program improvement and program outcome reporting. This includes analyzing information to identify…

Systems Analyst is responsible for planning, developing, testing and implementing IT system solutions that improve business efficiency and productivity as well as support business strategies and goals. They identify and communicate business needs and translate business requirements into technical system and functional specifications. Systems Analysts determine if internal or external solutions exist or whether new…

Will this position be required to work onsite for any reason at any time? Yes, vaccine is required. Engagement Description – Responsible for serving as a liaison between the Pharmacy Services Operations and PBM IT to provide technical solutions required for the achievement of business goals. Responsible for planning, organizing, directing, implementation, and leading department…

Intermediate Controls Specialist provides support for all plant floor related automation control based systems supported by the IT organization. Responsibilities include but not limited to: • Support includes the implementation of system changes, support of daily plant activities relating to these systems, and system management including the implementation of IT standards and incident management. •…

Engagement Description – Medical Records retrieval analyst. This role is responsible for retrieval metrics for various government and coding audits. This role also works with several departments to ensure record retrieval is at a high rate and has to coordinate retrieval efforts interdepartmentally and with clients. Top 3 Required Skills/Experience – • communication • project…

Engagement Description – This role will be responsible for the delivery of Policy Change Requests. The work includes but is not limited to business requirement assessment, detailed system analysis, benefit designs and testing. Top 3 Required Skills/Experience – • Strong medical and facility claims background, understanding of the billing process, ICD codes, procedure codes, diagnosis…

SUMMARY: Support providers (pharmacists and physicians) with Medicare Part D drug coverage inquiries, Grievances, and prior authorizations. RESPONSIBILITIES/TASKS: Answer telephones in an efficient and timely manner to lend appropriate assistance to providers. Process prior authorization requests under the supervision of a Clinical Pharmacist. Apply pharmacy prior authorization criteria used in the adjudication of pharmacy PA…

• 3 years’ experience in NASCO 3270 mainframe including preparing/executing test claims for all lines of business • Minimum 3 years’ experience in BFM/BFAST environment, GENO Table, Procedure & Diagnosis Files • Experience in CSR creation, updates & development • Knowledge of Medical, Benefit and Payment Policy • Ability to work effectively with multiple internal/external…

Top 3 Required Skills/Experience – • Knowledge of Stars, Risk Adjustment, Provider Network Management, and Medical Management. • Excellent analytical, planning, problem solving, verbal, and written skills to communicate complex ideas. • Ability to work independently, within a team environment, and communicate effectively with employees at all levels. Required Skills/Experience – The rest of the…