Strategic Enterprise Claims Rules & Edits Analyst
Waystar
A leading healthcare technology firm is seeking a smart, technical, and creative Enterprise Rules & Edits Analyst. This full-time role involves working with claim billing, coding, and authorization rules. Key responsibilities include collaborating with client support and technology teams, leveraging analytical tools, and developing processes for accurate claim edit configurations. Ideal candidates will have a degree or equivalent experience in healthcare and strong problem-solving and communication skills. Competitive benefits and flexible time off are offered. #J-18808-Ljbffr Waystar
- Waystar is seeking a smart, technical, and creative Enterprise Rules & Edits Analyst to grow their career working with claim billing, coding, and authorization rules. The analyst will report to the Director of Enterprise Rules & Edits and collaborate with client support...ClaimsFull timeLocal areaFlexible hours
- ...Summary The Pharmacy Revenue Cycle Analyst is responsible for ensuring optimal revenue... ...accuracy of inpatient and outpatient claims processing and reviewing denials and write... ...knowledgeable of pertinent pharmacy revenue cycle rules and regulations. This role will assist...ClaimsContract workWork experience placementWork at officeRemote work
$49.43k - $107.1k
...and timely maintenance of critical provider information on all claims and provider databases. Maintains critical provider information... ...data among multiple claims systems and application of business rules as they apply to each database. Validate data to be housed on provider...ClaimsWork experience placementWork at office- ...The Business Analyst, Pricing and Underwriting , is responsible for the compilation,... ...financial forecasting, and contribute to strategic economic modeling. Design and generate reports... ...business strategy. Analyze pharmacy claims, drug pricing, rebate models, and...ClaimsFull timeTemporary workWork at officeRemote workWork from home
- ...through comprehensive risk and insurance strategies. The ideal candidate will lead negotiations for claims, oversee insurance placements, and contribute to the Enterprise Risk Management program. Qualified applicants should possess a Bachelor's degree with at least 10...ClaimsWork at office
$45k - $55k
Talis Group, Inc. is seeking an Insurance Administrative Assistant to support their claims team with administrative coordination and document management. Ideal candidates will possess advanced Excel skills and strong organizational abilities. This full-time position offers...ClaimsFull time- ...Sr. Revenue Integrity Pharmacy Analyst The Sr. Revenue Integrity Pharmacy Analyst is responsible for expert review of pharmacy related... ..., and value analysis. They will review and analyze pharmacy claims, collaborating with pharmacy IS, Billing and Managed Care to ensure...ClaimsRemote job
- CCCA Analyst (Credit and Accounts Receivable Analyst) We believe great people build great... ...collection of overdue accounts, claims adjustment, and credit hold release. This... ...example: Google, Excel, and SAP or other enterprise system (input and query experience). Ability...ClaimsFlexible hours
- Norton Healthcare is seeking a Revenue Cycle Analyst to serve as the subject matter expert in payor reimbursements and medical policies. The role involves preparing and forwarding patient claims, ensuring compliance, and performing billing activities that influence cash...ClaimsRemote job
$49.43k - $107.1k
...Louisville, Kentucky, is seeking a qualified candidate to ensure accurate and timely maintenance of critical provider information across claims and provider databases. This role requires at least 2 years of health care experience along with skills in data analysis, Microsoft...ClaimsWork at office- Spectrum in Louisville, Kentucky is seeking a Business Analyst to evaluate operations and collaborate with stakeholders to drive organizational... ...business operations, compile and present data, and create strategic reports. The ideal candidate will have a Bachelor’s degree in...
- ...reimbursement accuracy and prevent revenue leakage. This role provides strategic oversight of revenue cycle risk areas, supports payer... ...requirements, while also analyzing denial trends, overseeing claim edit resolutions, and ensuring all revenue processes align with federal...Claims
- ...Road & Rail Services is looking for a Market Analyst to enhance our strategic growth by analyzing trends and opportunities in the Rail and Industrial logistics sectors. The ideal candidate will manage business opportunities, conduct market research, and create marketing...
- ...The Legal Analyst supports the warranty litigation team by managing warranty litigation claims and arbitration matters and assisting with litigation support activities as needed. This role works in close partnership with paralegals and warranty litigation attorneys to...ClaimsFull timeImmediate start
- ...We are looking for a seasoned workforce analyst who can build and own the models that drive... ...Job Responsibilities Include: Strategic Workforce Modeling & Planning Build and... ...planning, and workforce analytics in a mid to enterprise sized organization ~ Demonstrated...Temporary workLocal areaRemote workShift work
- ...and execution for our largest and most strategic vertical. This is a high-impact, fast-moving... ...resonate with carriers, adjusters, and claims leaders. Lead competitive intelligence... ...marketing enablement and content support for enterprise pursuits, renewals, and key product...ClaimsTemporary workLocal area
$21 per hour
...: The Pharmacy Adjudication Specialist will adjudicate pharmacy claims, review claim responses for accuracy. ensure prescription claims... ...Maintain a safe and clean pharmacy by complying with procedures, rules, and regulations and compliance with professional practice and...ClaimsFull timeTemporary workWork experience placementRelocation packageFlexible hoursShift work- ...formulate compelling clinical arguments. Efforts will apply to pre claim edits as well as pre- or post-payment audits from insurance carriers... ...knowledge of InterQual, Milliman Care Guidelines, and Coding Rules and Guidelines. Critical thinking skills. Strong oral and...ClaimsContract workWork at officeShift work
- Presque Isle Downs, Inc. is seeking a Settlements Revenue & Accounting Analyst in Louisville, KY. This role involves managing pari-mutuel invoicing, communication with third-party customers, and performing month-end closing duties. Candidates should possess a Bachelor's...
- ...Risk Management to lead the risk management program. This position is critical for ensuring patient safety and managing liability claims. Requirements include a Bachelor's degree, Kentucky RN license, and a minimum of 10 years in risk management. The role involves analyzing...Claims
- Responsibilities Assist in resolving billing edits that are holding patient claims from billing, by reviewing medical records and other applicable documentation. Position will serve as liaison between Revenue Integrity and Ancillary Departments regarding revenue and compliance...ClaimsRemote job
- ...passionate Administrative Specialist (Data Analyst) to join our team to support the U.S.... ...databases. Receive, suspense petitions, claims, and process requests. Reconcile... ...customers, helping them achieve excellent enterprise wide outcomes. As a certified Service-Disabled...ClaimsLocal area
$73.6k - $110.4k
Anticipated End Date: 2026-07-31 Position Title: Business Analyst III- Medicaid Overpayment Recovery Job Description: Title: Business... ...responsible for leading complex data analysis and mining efforts using claims data and coding methodologies (CPT, HCPCS, DRG, ICD-9, ICD-10)...ClaimsFull timeContract workTemporary workWork experience placementWork at officeLocal areaDay shift2 days per week1 day per week- ...AMFEMS when requested. Work with CRR division and AMFEMS colleagues to accomplish strategic initiatives and goals. Tools and Resources Used District owned vehicle Laptop or tablet Enterprise record management system (RMS) software Office software and applications...Full timeTemporary workPart timeWork experience placementWork at officeWeekend workAfternoon shift
- Sedulo Group in Louisville, KY (or remote) is looking for a motivated Business Development Coordinator to help drive growth. You will engage potential clients, manage sales leads, and collaborate with experts to support business efforts. This entry-level position requires...Remote job
$172.2k - $236.9k
...Solutions Strategist provides strategic advice and guidance to... ...-making across the enterprise. In this high-impact... ...and Medicaid), claims, pharmacy, clinical systems... .... Define and enforce rules for systems of record... ...leaders and business analysts to understand end-to-end...ClaimsFull timeTemporary workFor contractorsApprenticeshipWork from homeHome office- ...Bodily Injury Claims Representative A career at Auto-Owners is challenging and rewarding. Our group of caring associates create financial... ...and in accordance with any applicable law, regulation, or rule. Assist in the evaluation and selection of outside counsel....ClaimsWork at officeLocal areaWork from home3 days per week
- ...team members, Valeris provides the data and strategic insights, patient support services and... ...in onsite education of program business rules, payer coverage, and other reimbursement... ...programs representatives on patient cases and claim issues. Educate office staff on the use...ClaimsWork at officeLocal area
- Actuarial Analyst II Location: This role requires associates to be in-office 1 - 2 days per week, fostering collaboration and connectivity... ...reporting and forecasting. Analyze and monitor weekly incurred claims, paid claims, pharmacy, lab, and authorization data to identify...ClaimsWeekly payTemporary workWork at officeLocal areaShift work2 days per week1 day per week
- Brown-Forman is hiring an IT Governance/Risk/Compliance Analyst in Louisville, KY. This role involves developing and maintaining IT governance frameworks, supporting risk management programs, and ensuring compliance with internal policies and external regulations. The ideal...
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