Reimbursement analyst jobs near me

Client: Leading Investment Bank Contract Term: Onsite role Note: we do not take visa transfers or support sponsorship. This is not a C2C / 1099 role. We are seeking an AML Compliance Analyst Basic for a very important client. Pluses that could set you apart! • Hands on AML, KYC, fraud, or investigations experience. • SAR (Suspicious Activity Report) writing skills. • Excel expertise in VLOOKUPs and Pivot Tables. • Bachelor's Degree, preferably in Criminal Justice or a similar field. Job Responsibilities • Collect and analyze data, including alert, transactions, customer demographics and relevant account information to identify potential suspicious activity • Disposition and fully document the investigation, including supporting data, analysis, and rationale for disposition within the case management system • Complete the Suspicious Activity Report (SAR) form , if applicable, in accordance with Financial Crimes Enforcement Network (FinCEN) requirements • Effectively communicate with associates, management and various stakeholders on risks identified, possible typologies and recommend next steps • Balance inventory queues, deadlines, and priorities to achieve departmental standards and production goals. • Demonstrate teamwork by accepting ad-hoc requests to assist other associates on inventory Interpretation of AML Risk standards, guidelines, policies and procedures. Make risk based determination through Quality Analysis whether alerts were properly cleared by Compliance Alerts Analysts. Ensure Alert data has been accurately collected and documented, including but not limited to: Investigations data, Suspicious Activity Reports (SARS) & Currency Transaction Reports (CTR), Know Your Customer (KYC) information, any relevant account and transaction data and all required information which would assist in an investigation. Strong research, analytical and comprehension skills, with ability to analyze large amounts of data. The ideal candidate will possess the following qualifications: Required Qualifications, Capabilities, and Skills • Exceptional written and verbal communication skills • Strong analytical, interpretive, organizational skills • Strong attention to detail, ability to prioritize and manage tasks • Independent decision maker, able to make time-sensitive assessments and articulate findings to senior investigators or managers • Knowledge of banking products and services • Understanding of regulatory concepts including, but not limited to, the Bank Secrecy Act, Office of Foreign Assets Control sanctions, and the USA PATRIOT Act • Proficient in MS Office (Outlook/Word/Excel/Access/PowerPoint)

Job Title: DMS/EMS/SCADA Analyst (Onsite) Duration: 12-month contract (W2 only) Schedule: Mon-Fri, 8am-5pm (OT as needed) Travel: ~5% to Gahanna, OH Possibility of conversion | No sponsorship About the Role We are seeking a DMS/EMS/SCADA Analyst to support real-time operational systems for Distribution and Transmission Operations. This role is 100% onsite and requires hands-on experience with SCADA, DMS, or EMS systems in an electric utility environment. Responsibilities Maintain and support DMS/EMS/SCADA systems and real-time data interfaces Build and maintain SCADA models, on-line displays, and tools Support RTU modeling, configuration, checkout, and commissioning Troubleshoot SCADA technical issues and provide after-hours support when needed Improve system reliability, data quality, and SCADA processes Assist Protection & Control Engineering with SCADA standards and configuration Participate in small/medium SCADA project scoping Train and support junior analysts Minimum Qualifications Associate Degree in Computer Science, Electrical Engineering, Telecommunications, or related field OR High school diploma + 5 years DMS/EMS/SCADA experience OR Bachelor's Degree + 1 year DMS/EMS/SCADA experience 3+ years experience with DMS/EMS/SCADA systems (utility preferred) Strong skills in: Application development OS support System administration Database technologies (any 2 required) Required Skills Hands-on experience with SCADA systems Understanding of real-time operations and field equipment Experience with RTUs, I/O settings, alarms, and communication protocols Strong troubleshooting, communication, and organizational skills Ability to work onsite full-time and support occasional after-hours issues Preferred Skills Experience with TOPS SCADA Knowledge of Protection & Control (P&C) applications Familiar with legacy communication technologies (async/sync)

Reporting directly to the Director, AR Reimbursement and Statutory accounting, the Sr. Analyst, Reimbursement Medicare is responsible for providing accurate information for Medicare cost report preparation, cost report appeals, audit preparation and other duties related to the regulatory reimbursement services. The position maintains current knowledge of Medicare, Medicaid and other State and Federal regulations. The Sr. Analyst interacts with customers and ensures value is delivered and customer satisfaction is achieved. The Sr. Medicare Reimbursement Analyst also assists in the AR closing processes and meeting future reimbursement service needs. Estimated salary range for this position is $65,835.36 - $85,585.97 / year depending on experience. Degrees: * Bachelors. Additional Qualifications: * Bachelor's degree in Accounting or Finance. * MBA or Master of Accounting degree preferred. * Strong analytical and quantitative thinker. * Five years of accounting and or financial analysis experience in healthcare environment. * Possess knowledge of Medicare Cost report and Medicare, Medicaid and other State and Federal regulations. * Experience with Graduate Medical Education (GME) and Indirect Medical Education (IME) preferred * Strong budget and analytical skills required, including knowledge of management information systems, proficient skills in Excel, Word, JDA, Epsi, Cerner, ProDiver, RCA and excellent communication skills. Minimum Required Experience: 5 years

Sr Reimbursement Medicare Analyst, REMOTE, FT, 08A-4:30P-148580Baptist Health is the region's largest not-for-profit healthcare organization, with 12 hospitals, over 29,000 employees, 4,500 physicians and 200 outpatient centers, urgent care facilities and physician practices across Miami-Dade, Monroe, Broward and Palm Beach counties. With internationally renowned centers of excellence in cancer, cardiovascular care, orthopedics and sports medicine, and neurosciences, Baptist Health is supported by philanthropy and driven by its faith-based mission of medical excellence. For 25 years, we've been named one of Fortune's 100 Best Companies to Work For, and in the 2024-2025 U.S. News & World Report Best Hospital Rankings, Baptist Health was the most awarded healthcare system in South Florida, earning 45 high-performing honors.What truly sets us apart is our people. At Baptist Health, we create personal connections with our colleagues that go beyond the workplace, and we form meaningful relationships with patients and their families that extend beyond delivering care. Many of us have walked in our patients' shoes ourselves and that shared experience fuels out commitment to compassion and quality. Our culture is rooted in purpose, and every team member plays a part in making a positive impact - because when it comes to caring for people, we're all in. Description Reporting directly to the Director, AR Reimbursement and Statutory accounting, the Sr. Analyst, Reimbursement Medicare is responsible for providing accurate information for Medicare cost report preparation, cost report appeals, audit preparation and other duties related to the regulatory reimbursement services. The position maintains current knowledge of Medicare, Medicaid and other State and Federal regulations. The Sr. Analyst interacts with customers and ensures value is delivered and customer satisfaction is achieved. The Sr. Medicare Reimbursement Analyst also assists in the AR closing processes and meeting future reimbursement service needs. Estimated salary range for this position is $65,835.36 - $85,585.97 / year depending on experience.Qualifications Degrees: Bachelors. Additional Qualifications: Bachelor‘s degree in Accounting or Finance. MBA or Master of Accounting degree preferred. Strong analytical and quantitative thinker. Five years+ of accounting and or financial analysis experience in healthcare environment. Possess knowledge of Medicare Cost report and Medicare, Medicaid and other State and Federal regulations. Experience with Graduate Medical Education (GME) and Indirect Medical Education (IME) preferred Strong budget and analytical skills required, including knowledge of management information systems, proficient skills in Excel, Word, JDA, Epsi, Cerner, ProDiver, RCA and excellent communication skills. Minimum Required Experience: 5 years Job CorporatePrimary Location Coral GablesOrganization CorporateSchedule Full-time Job Posting Mar 3, 2025, 5:00:00 AMUnposting Date OngoingEOE, including disability/vets

Guided by our core values and commitment to your success, we provide health, financial and lifestyle benefits to ensure a best-in-class employee experience. Some of our offerings include: Highly competitive total rewards package, including comprehensive medical, dental and vision benefits as well as a 401(k) plan that both the employee and employer contribute Annual incentive bonus plan based on company achievement of goals Time away from work including paid holidays, paid time off and volunteer time off Professional development courses, mentorship opportunities, and tuition reimbursement program Paid parental leave and adoption leave with adoption financial assistance Employee discount program Summary: The Medical Coding and Reimbursement Analyst researches, coordinates, analyzes, and provides coding expertise in the application of medical and reimbursement contracting, configuration, and benefit mapping. Follows company guidelines and refers issues to appropriate coding, billing, and coverage requirements, as necessary. Acts as a coding subject matter expert resource to internal customers. Able to perform all duties with limited supervision.Job Description Provides analysis and recommendations to Contracting, Provider Payment, Provider Solutions, and Medical Policy team as it relates to coding, bundling, modifiers, clinical edits, benefits, and enforcements Participates in provider / client / network meetings, which may include provider education through written communication. Reviews complex operative reports and provider information regarding procedures, clinical edits, and fee schedules. Reviews appropriate use of modifiers and codes being submitted by providers to ensure appropriate reimbursement and billing practices. Interprets state and federal mandates, applicable benefit language, medical & reimbursement policies, coding requirements and consideration of relevant clinical information to develop coding recommendations and payment policies. Timely and accurate publishing of Payment Policies to Blue KC website Evaluates process outcomes, provides recommendations from a code perspective for improvements across multiple lines of business. Educates, investigates and assists internal customers regarding correct procedural coding for benefit, claim and system questions. Requests and reviews claims/analytical reports; provide utilization summaries on coding/provider billing practices that may result in an enforcement, benefit, or payment policy change(s). Develop proactive and positive working relationships with other departments within Blue KC to successfully drive accurate and timely initiatives related to medical codes, contracting, and reimbursement. Communicates effectively with team members, team leadership, and other management. Minimum Qualifications Bachelor's degree from an accredited university or college in Healthcare Administration, Business, Information Systems or a related academic field; OR five (5) years of relevant experience providing the types and levels of knowledge, skills, and abilities required by the job. Certified Coder with AHIMA or AAPC 3 years of professional experience working with operational and/or analytical processes, preferably within the healthcare industry or managed care payer. Must be task oriented and able to meet designated deadlines; productivity standards and able to work independently. Ability to read, analyze and interpret general business periodicals, professional journals, technical procedures, operative reports or governmental regulations. Ability to write reports, business correspondence and business manuals. Ability to effectively present information in one-on-one and small group situations to customers, clients and other employees of the organization. Ability to calculate figures and amounts such as discounts, interest, commissions, proportions, and percentages. Ability to define problems, collect data, establish facts and draw valid conclusions. Ability to interpret an extensive variety of technical instructions and deal with several abstract and concrete variables. Intermediate knowledge of medical claims processing. Intermediate level knowledge of Microsoft Office Word, Excel, and Access, or similar PC-based programs. Preferred Qualifications 5 years of professional experience working with operational and/or analytic processes, preferably within the healthcare industry or managed care payer. Strong understanding of Blue KC core systems (including Facets, Claims Xten, and NetworX) Strong understanding of Blue KC claims, reimbursement, and benefit structures. Blue Cross and Blue Shield of Kansas City is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to, among other things, race, color, religion, sex, sexual orientation, gender identity, national origin, age, status as a protected veteran, or disability.

Welcome! We're excited you're considering an opportunity with us! To apply to this position and be considered, click the Apply button located above this message and complete the application in full. Below, you'll find other important information about this position. The primary focus of this position is to design reports and analyze data from various sources in order to prepare cost reports and other reimbursement filings as required by regulatory agencies. Extensive knowledge of third-party reimbursement regulations is required in order to file reports accurately and to inform management and other areas of the organization of the impact of changing reimbursement regulations, filings, etc. Excellent communication skills are imperative to coordinate information from various levels of the organization, with Medicare and Medicaid auditors, external vendors, etc. Must be able to use critical thinking and analysis skills, experience, and insight to promptly, accurately, and effectively address issues, questions, complete projects, meet deadlines, etc. without direct management or other leadership involvement. Must be able to operate independently in highly efficient and effective manner. MINIMUM QUALIFICATIONS: EDUCATION, CERTIFICATION, AND/OR LICENSURE: 1. Bachelor's Degree. OR 2. HFMA Certified Hospital Cost Report Specialist (CHCRS). EXPERIENCE: 1. Successful completion and submission of Medicare Cost reports for two or more (2+) years for Critical Access and/or Acute/IPPS facilities and successful navigation of at least two (2+) years of corresponding reviews, surveys, and audits (Interim rate reviews, S-10, Bad Debt, Charity Care, DSH, Wage Index, Occupational Mix, desk review, etc.) 2. Experience with hospital electronic health record systems (EPIC, Cerner, etc.), Cost Reporting applications, general ledger/accounting systems, and CMS/MAC cost reporting procedure, process, completion, submission, supporting schedules and documentation requirements, regulation, strategy, and audit. 3. Advanced computer and spreadsheet skills, primarily in Excel. PREFERRED QUALIFICATIONS: EXPERIENCE: 1. Three (3) experience in healthcare accounting (general ledger, trial balance, income statement, balance sheet, cash flow, etc.), finance, revenue cycle, data analysis, and/or reimbursement. CORE DUTIES AND RESPONSIBILITIES: The statements described here are intended to describe the general nature of work being performed by people assigned to this position. They are not intended to be constructed as an all-inclusive list of all responsibilities and duties. Other duties may be assigned. 1. Supports all third-party cost reports (Medicare, WV Medicaid, PA Medicaid, Ohio Medicaid, Champus/Tricare, etc.) and any analysis, updates, changes, etc. to facilitate any necessary amendments as needed. Directly supports audits/reviews of these reports and any other associated audits (including but not limited to Wage Index, Occupational Mix, DSH, S-10, Bad Debt, Charity Care, NAHE, and DGME/IME). Coordinates within the department to address and support any applicable review/audit. 2. Coordinates compiling of all data required for completion of any audits from various departments systems and external sources. Provides updates on status and monetary impact of all filings/deadlines, settlements, amendments, audits, adjustments, etc. and regularly tracks, updates, and communicates with necessary parties regarding any and all reimbursement items. 3. Conducts research and provides documentation and explanations for all necessary workpapers, schedules, and forms and updates workpapers, schedules, applications and software (including but not limited to Absolute, and HFS systems/files) promptly and accurately. Performs all necessary reimbursement impact analysis, technical completion/submission review, analysis, and strategy and identifies strategy. methodology, and efficiencies to minimize losses and improve reimbursement as well as regulatory/audit risk and/or opportunity. 4. Analyzes data from all sources to ensure accuracy, consistency, and technical correctness in accordance with all regulatory and audit requirements/interpretations. 5. Assists with and prepares reimbursement budget models with accuracy using the most current, proposed and final regulations. 6. Assists with and prepares the Uniform Report for the WV Healthcare Authority annually as needed. 7. Analyzes current rate structure and develops current and future impact based on reviews/audits in addition to reconciling adjustment impact prior to acceptance. Responsible for distributing updated rates and estimated impact to internal departments. 8. Maintain and continually improve on technical skills needed to manipulate and analyze data. 9. Utilize and develop database report writing skills in Strata and other systems as needed. Analyze current report setup/processes for accuracy and efficiency. 11. Assists with completion, analysis, and submission of Medicaid DSH Survey and DSH audit annually. Conducts all necessary analysis and opportunity/risk assessment and develops reporting and technical efficiencies and strategies. 12. Analyzes data and compiles supporting documentation for Wage Index and Occupational Mix, transplant, Nursing and Allied Health, Bad Debt, Charity Care, S-10, desk review, IME/GME Overlap, time studies/time allocation, etc. and develop technical and reporting efficiencies and improvements. Directly responsible for answering questions during the review/audit of these and any other items, providing supporting documentation and rationale, data entry, template compliance, invoice research and compilation, etc. 13. Provides necessary data and support to the reimbursement team to calculate third party receivables and payables as needed. 14. Provide analytical interpretation and substantiation during the Hospital's annual financial audit and annual governmental audits as needed in addition to any other support that be required 15. Coordinates reimbursement projects with various consultants as dictated by the needs and requirements of the project and the department. 16. Participates in meeting the objectives of the work unit and goals of the department. 17. Promotes and contributes positively to the teamwork of the department by assisting co-workers, contributing ideas and problem-solving with co-workers. 19. Identifies and addresses problems, questions, concerns, analysis, etc. in a timely manner so that proper actions can be implemented to prevent losses, maximize reimbursement, and meet deadlines, to facilitate the growth and stability of the organization. 20. Provides any other support to the Finance and Reimbursement Department as needed and coordinates activity with department leadership 21. Must be able to operate independently in a highly efficient and effective manner and replicate prior year workpapers, support, documentation, etc. as required without direct oversight or other involvement from leadership or other staff. 22. Effectively communicate and collaborate in a team atmosphere to fulfill their responsibilities and meet deadlines utilizing excellent communication skills, prioritization, critical thinking, and data analysis skills 23. Support performance improvement and quality assurance initiatives. 24. Participate in educational opportunities as provided by the hospital to enhance skill related abilities. PHYSICAL REQUIREMENTS: The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. 1. Frequent walking, standing, stooping, kneeling, reaching, pushing, lifting, grasping and feeling are necessary body movements utilized in performing duties through the work shift. 2. Must be able to sit for extended periods of time. 3. Must be able to read and write legibly in English. 4. Visual acuity must be within normal range. 5. Must have hearing abilities in order to communicate effectively via telephone and in person. 6. Must have reading and comprehensive ability. WORKING ENVIRONMENT: The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. 1. Office type environment. 2. Ability to work remotely. SKILLS AND ABILITIES: 1. Extensive experience in financial analysis and interpretation of federal and state regulations. 2. Specialized knowledge of hospital healthcare reimbursement, including but not limited to cost reporting, bad debt (including the reserve and posting process), S-10, Wage Index/Occupational Mix, DSH, 340b, and rate setting. 3. Strong communication skills are necessary to interact effectively with management, staff and external auditors. 4. Excellent analytical, critical thinking, and problem-solving abilities with the ability to manipulate and understand complex information and robust data sets and calculations. 5. Effective organizational and time management skills with the proven ability to meet deadlines with precision, intention, and efficiency. 6. Proficiency in Microsoft Office Suite (Excel, Access, Word, Outlook) and other fundamental computer skills. 7. Ability to work effectively and independently managing tasks in a fast-paced environment. Additional Job Description: Scheduled Weekly Hours: 40 Shift: Exempt/Non-Exempt: United States of America (Exempt) Company: SYSTEM West Virginia University Health System Cost Center: 540 SYSTEM Finance and Reimbursement

We take great strides to ensure our employees have the resources to live well, be healthy, continue learning, develop skills, grow professionally and serve our local communities. We invite you to apply for a career with Blue Cross. Residency in or relocation to Louisiana is preferred for all positions. POSITION PURPOSE Independently researches, analyzes, develops and maintains new and existing, complex reimbursement programs. Designs system specifications that support claims payment and criteria for data bases that support analysis as well as training documentation describing programming, billing and payment guidelines for internal and external use. Designated staff may focus primarily on supporting the Medicare Advantage line of business. NATURE AND SCOPE This role does not manage people This role reports to this job: MANAGER, PROVIDER REIMBURSEMENT Necessary Contacts: In order to effectively fulfill this position the incumbent must be in contact with: All levels of internal personnel, with primary contacts in Network Administration, IT, Medical Management, Benefits Administration, Actuarial, Legal, Executive, Marketing, and Underwriting. Providers, provider representatives, consultants, provider specialty organizations, AMA, vendor reps, and hospital administrators to exchange or review program information. Other data sources are market research consultants, AMA, St. Anthony, Relative Value Studies for Dentists, Dun and Bradstreet and HIAA, CMS, Blue Cross and Blue Shield Association, Blue Cross and Blue Shield Plans, CMS, DHS, sales and marketing regional offices. QUALIFICATIONS Education Bachelor's degree in statistics, accounting, finance, math or related field is required Prefer a Master's Degree or pursuit of a Master's degree in Business, Information System and Decision Sciences, Healthcare Administration or Public Health. Four years of related experience can be used in lieu of a Bachelor's degree. Work Experience 4 years of experience in the health industry accounting functions including billing, coding, Medicare or statistical analysis of financial information is required Provider contract analysis and/or reimbursement program implementation experience is strongly is preferred Skills and Abilities Must have acquired sufficient knowledge to function autonomously and to know the appropriate contacts within departments to resolve specific issues for all lines of business. Excellent analytical, oral and written communication, and report preparation skills with highest degree of accuracy are required. Must have the ability to effectively present information to Executive Management and all levels of employees. Requires strong math/analytical skills including variance analysis, statistical formulas, algebraic formulas, percentages, multiplication and division, fractions and reasonableness tests. Excellent attention to detail, research, and documentation skills are required. Proficiency with commonly used database, spreadsheet and word processing software is required. Must have extensive knowledge to select the appropriate database format and structure for the type of information to be captured and reported. Familiarity with relational database software, mainframe capabilities, FOCUS and SQL programming is helpful and preferred. Must be able to create and maintain required databases as determined by supervisor. A strong understanding of physician charge practices and billing methodologies is helpful. Minimal travel is required. Travel may involve going to regional offices and/or conferences and exhibits. Staff dedicated to supporting Medicare Advantage must have working knowledge of Medicare enrollment guidelines and reimbursement. Licenses and Certifications Pursuit of coding (CPC or CPHC) designation is preferred ACCOUNTABILITIES AND ESSENTIAL FUNCTIONS Serves as provider reimbursement technical advisor and/or committee participant to Information Technology staff, Benefits Administration staff, Provider Audit, Network Administration and/or Medicare Advantage staff, and entry level Reimbursement Analyst by developing and implementing project/program narratives and responding to concerns on new and existing reimbursement programs, billing guidelines, and system requirements to ensure accurate implementation and maintenance of provider reimbursement programs. Identifies claims and provider reimbursement related system problems, including claims coding and processing issues, coordinates research, audit, and recommendations with Provider Audit, and implements and monitors system changes to resolve any problems. Researches, designs, implements, and maintains complex hospital or professional provider reimbursement programs for traditional and managed care programs and Medicare Advantage. Contact other plans, consultants, and local providers to assist in program specifications. Proactively monitors health care and health industry developments, including CMS/Medicare eligibility, EGWP and methodology changes. Analyzes and produces management reports to monitor effectives and identify and resolve deficiencies of reimbursement programs in comparison to industry benchmarks, competitors, and Medicare. Leads in the development of complex financial pricing models and financial data analysis to support modifications to reimbursement programs and monitor effectiveness of pricing logic. Provides statistical reports to Network Administration, Medical Management, Marketing and Medicare Advantage to support internal strategies and external customer needs, such as contract negotiations and marketing efforts. Complies with Corporate Objectives on project implementation and schedule deadlines. Ensures proper workflow by assessing reimbursement processes and recommending improvement as well as coordinating projects and time frames with less senior reimbursement staff. Accountable for complying with all laws and regulations associated with duties and responsibilities. Additional Accountabilities and Essential Functions The Physical Demands described here are representative of those that must be met by an employee to successfully perform the Accountabilities and Essential Functions of the job. Reasonable accommodations may be made to enable an individual with disabilities to perform the essential functions Perform other job-related duties as assigned, within your scope of responsibilities. Job duties are performed in a normal and clean office environment with normal noise levels. Work is predominately done while standing or sitting. The ability to comprehend, document, calculate, visualize, and analyze are required. #LI_CB1 An Equal Opportunity Employer All BCBSLA EMPLOYEES please apply through Workday Careers. PLEASE USE A WEB BROWSER OTHER THAN INTERNET EXPLORER IF YOU ENCOUNTER ISSUES (CHROME, FIREFOX, SAFARI) Additional Information Please be sure to monitor your email frequently for communications you may receive during the recruiting process. Due to the high volume of applications we receive, only those most qualified will be contacted. To monitor the status of your application, please visit the "My Applications" section in the Candidate Home section of your Workday account. If you are an individual with a disability and require a reasonable accommodation to complete an application, please contact ********************* for assistance. In support of our mission to improve the health and lives of Louisianians, Blue Cross encourages the good health of its employees and visitors. We want to ensure that our employees have a work environment that will optimize personal health and well-being. Due to the acknowledged hazards from exposure to environmental tobacco smoke, and in order to promote good health, our company properties are smoke and tobacco free. Blue Cross and Blue Shield of Louisiana performs background and pre-employment drug screening after an offer has been extended and prior to hire for all positions. As part of this process records may be verified and information checked with agencies including but not limited to the Social Security Administration, criminal courts, federal, state, and county repositories of criminal records, Department of Motor Vehicles and credit bureaus. Pursuant with sec 1033 of the Violent Crime Control and Law Enforcement Act of 1994, individuals who have been convicted of a felony crime involving dishonesty or breach of trust are prohibited from working in the insurance industry unless they obtain written consent from their state insurance commissioner. Additionally, Blue Cross and Blue Shield of Louisiana is a Drug Free Workplace. A pre-employment drug screen will be required and any offer is contingent upon satisfactory drug testing results.

Start the day excited to make a difference…end the day knowing you did. Come join our team. EPIC Payor Reimbursement Analyst must have strong proficiency and knowledge application of providing analytic expertise in the following areas: Epic HB/PB contract build and modeling functions, healthcare financial and payor software systems, payor financial impact/trend analysis reports and managed care contracting knowledge. This role will require extensive knowledge of internal financial systems, ability to manipulate/present a wide data range upon request and understanding of financial impacts of managed care contracting to organization budgets. This position must demonstrate a commitment of quality service to our patients, the community, and our internal/external customers. * At this time, this position is open to candidates located in and authorized to work in the United States who reside in one of the following states: VA, NC, SC, GA, FL, NE, TX, WI, LA, ME, WV, TN, LA, NH, IA and OH* Essential Functions & Responsibilities Epic HB Resolute Function: * Understanding and analysis of contracts, components, component groups, selection extensions, pricing extensions, hospital billing rules and many more items within the resolute * Interpretation and loading of multiple fee schedules used within HB contracting Epic PB Resolute Function: * Interpretation and loading multiple fee schedules used within PB contracting Epic HB/PB Resolute Function: * Optimization of previously built contracts and creation of "new" contracts within the epic Contract Maintenance * Build contracts within Epic that reimburse by DRG, percentage of billed charges, grouper rates, case rates, global case rates, per diem and contain lesser of and stop bill language, for utilization in expected reimbursement calculations * Analyze, build, test, deploy and maintain Payor Relations contracts/fee schedules and system related functions * Monitor, analyze and test interface projects and upgrades to ensure contract pricing and language are appropriate * Utilizes contract modeling/cost accounting software to analyze/model the impact of contract rate proposals between MWHC and Payors * Maintain knowledge in technical workflow and identify/communicate trends Payor Relations Function: * Analyzes and produces payor financial impact analysis for all contract proposals for HB/PB * Performs retrospective impact analysis against organization budget to ensure contractual financial results meet set financial targets * Analyzes the reimbursement impact of changes in government regulations, regulatory code changes/deletions/revisions, key managed care contracts, and third-party billing policies or requirements and reports financial impact to Manager. * Utilize Excel to do the data analysis; data comes from Epic * Performance of other duties assigned Qualifications and Certifications: Required * Minimum 3 years relevant experience * Certified in applicable Epic application and/or certified within six months of hire * Strong understanding of payor reimbursement coding (e.g., DRG, CPT, RC, HCPCS, OPPS, APC) * Strong understanding of HB/PB workflows, analytics and technology * Ability to prioritize multiple projects * Strong verbal, written and presentation skills * Ability to maintain professionalism and work within a team environment across multiple disciplines and teams Preferred * Certified in Healthcare Financial Professional (CHFP) * Strong understanding of HB/PB revenue cycle functions and payor contracting * Strong computer skills relevant to position; extensive experience using Excel, Access Database, knowledge of Lawson and Siemen's systems and DSS/Managed Care contract modeling software As an EOE/AA employer, the organization will not discriminate in its employment practices due to an applicant's race, color, religion, sex, sexual orientation, gender identity, national origin, and veteran or disability status.

Start the day excited to make a difference…end the day knowing you did. Come join our team. EPIC Payor Reimbursement Analyst must have strong proficiency and knowledge application of providing analytic expertise in the following areas: Epic HB/PB contract build and modeling functions, healthcare financial and payor software systems, payor financial impact/trend analysis reports and managed care contracting knowledge. This role will require extensive knowledge of internal financial systems, ability to manipulate/present a wide data range upon request and understanding of financial impacts of managed care contracting to organization budgets. This position must demonstrate a commitment of quality service to our patients, the community, and our internal/external customers. ***At this time, this position is open to candidates located in and authorized to work in the United States who reside in one of the following states: VA, NC, SC, GA, FL, NE, TX, WI, LA, ME, WV, TN, LA, NH, IA and OH*** Essential Functions & Responsibilities Epic HB Resolute Function: Understanding and analysis of contracts, components, component groups, selection extensions, pricing extensions, hospital billing rules and many more items within the resolute Interpretation and loading of multiple fee schedules used within HB contracting Epic PB Resolute Function: Interpretation and loading multiple fee schedules used within PB contracting Epic HB/PB Resolute Function: Optimization of previously built contracts and creation of “new” contracts within the epic Contract Maintenance Build contracts within Epic that reimburse by DRG, percentage of billed charges, grouper rates, case rates, global case rates, per diem and contain lesser of and stop bill language, for utilization in expected reimbursement calculations Analyze, build, test, deploy and maintain Payor Relations contracts/fee schedules and system related functions Monitor, analyze and test interface projects and upgrades to ensure contract pricing and language are appropriate Utilizes contract modeling/cost accounting software to analyze/model the impact of contract rate proposals between MWHC and Payors Maintain knowledge in technical workflow and identify/communicate trends Payor Relations Function: Analyzes and produces payor financial impact analysis for all contract proposals for HB/PB Performs retrospective impact analysis against organization budget to ensure contractual financial results meet set financial targets Analyzes the reimbursement impact of changes in government regulations, regulatory code changes/deletions/revisions, key managed care contracts, and third-party billing policies or requirements and reports financial impact to Manager. Utilize Excel to do the data analysis; data comes from Epic Performance of other duties assigned Qualifications and Certifications: Required Minimum 3 years relevant experience Certified in applicable Epic application and/or certified within six months of hire Strong understanding of payor reimbursement coding (e.g., DRG, CPT, RC, HCPCS, OPPS, APC) Strong understanding of HB/PB workflows, analytics and technology Ability to prioritize multiple projects Strong verbal, written and presentation skills Ability to maintain professionalism and work within a team environment across multiple disciplines and teams Preferred Certified in Healthcare Financial Professional (CHFP) Strong understanding of HB/PB revenue cycle functions and payor contracting Strong computer skills relevant to position; extensive experience using Excel, Access Database, knowledge of Lawson and Siemen's systems and DSS/Managed Care contract modeling software As an EOE/AA employer, the organization will not discriminate in its employment practices due to an applicant's race, color, religion, sex, sexual orientation, gender identity, national origin, and veteran or disability status.

For one of our ongoing project, we are looking for a Business analyst experienced on Cerner / Oracle EMR EHR. This is a 100% Remote role and can be done on a Part Time or Full time Basis. Only Local Wisconsin residents will be considered. Job Description Good understanding of Scheduling and Registration, HIM, Provider, Pharmacy, lab and · Nursing Workflows is needed. B.A. shall have experience with the ability to understand and document business requirements for reporting in a HIPAA regulated environment. Good business process mapping and process capture through Visio flow diagrams is also required. Experience in change management systems. Knowledge of vendor-based application release cycle and ticket management. Ability to identify integration points. Knowledge of reporting and dashboard maintenance. Experience in process improvements and I.T. systems integration. Ability to work with cross-functional teams. Ability to work with business teams and good communication and presentation skills. Experience in User Acceptance Testing (UAT), running regression tests on systems, and · identifying, designing, and optimizing new and existing test cases. JIRA tool experience. (nice to have) Experience with SQL, PL SQL and CCL code writing. Existing knowledge of Discern Reporting Portal (Static and Interactive Reporting) Existing Knowledge of Business Objects Reporting Solution.

At Angi , we've had one simple mission for 30 years: get jobs done well. We make it happen by connecting homeowners with reliable pros who have the skills they need - and connecting pros with homeowners who have the jobs they want. Angi at a glance: Homeowners have turned to Angi for more than 300 million projects 1,000+ home service tasks covered 2,800 employees worldwide Why join Angi: Angi is defining the future of the home services industry, creating an environment where homeowners, pros, and employees benefit from more jobs done well. For homeowners, our platform is a reliable way to find skilled pros. For pros, we're a reliable business partner who helps them find the winnable work they want, when they want. For employees, we're an amazing place to call home. We can't wait to welcome you. The Role: We are seeking an experienced and data-driven Staff Analyst to join our team as a senior individual contributor. This role will focus on optimizing the performance of our home repair and online marketplace platform by leveraging advanced analytics to drive strategic business decisions. You will work closely with product managers, marketing, and operations teams to analyze consumer behavior, market trends, service provider performance, and platform efficiency. As a key contributor, you will provide data-backed insights to enhance the user experience, increase platform engagement, and improve operational efficiency. What you'll do: Analyze user behavior, marketplace dynamics, and service provider performance to identify growth opportunities and areas for improvement. Develop predictive models to enhance marketplace matching (e.g., home repair service providers to customers), pricing optimization, and user retention strategies. Work cross-functionally to provide data-driven insights for feature enhancements, platform updates, and A/B testing initiatives. Present findings and recommendations to senior leadership, contributing to overall business strategy and platform growth. Create dashboards and reports to monitor key marketplace metrics (e.g., response times, job completions, user satisfaction) in real-time. Ensure data integrity by collaborating with data engineering teams to maintain accurate, scalable data solutions. Mentor junior analysts and assist in refining analytics processes, models, and reporting tools. Stay current with trends in the home services industry, online marketplace developments, and emerging data tools to keep our platform competitive. Who you are Bachelor's degree in Data Science, Economics, Statistics, Business, or a related field (Master's degree preferred). 8+ years of analytical experience in an e-commerce, marketplace, or home services-related field. Strong proficiency in SQL as well as data analysis tools such as Python or R. Expertise in data visualization tools such as Tableau, Power BI, or Looker. Proven ability to develop and apply predictive models to enhance marketplace performance. Strong communication skills to present complex data to cross-functional teams and non-technical stakeholders. Ability to manage multiple projects independently in a fast-paced environment. Experience in coaching or mentoring junior team members. We value diversity We know that the best ideas come from teams where diverse points of view uncover new solutions to hard problems. We welcome and value individuals who bring diverse life experiences, educational backgrounds, cultures, and work experiences. Compensation & Benefits The salary band for this position ranges $125,000 - $200,000 commensurate with experience and performance. Compensation may vary based on factors such as cost of living. This position will be eligible for a competitive year end performance bonus & equity package. Full medical, dental, vision package to fit your needs Flexible vacation policy; work hard and take time when you need it Pet discount plans & retirement plan with company match (401K) The rare opportunity to work with sharp, motivated teammates solving some of the most unique challenges and changing the world #LI-Remote

Why Canopy USA? HSCP Service Company LLC is a subsidiary of Canopy USA, LLC, a leading vertically integrated, multi-state operator in the United States cannabis industry. With the transition of Acreage Holdings to Canopy USA, LLC in December 2024, Canopy USA, LLC is now positioned to consolidate operations across its three business units - Wana, Jetty, and Acreage - realizing synergies, cost savings, and supporting growth in state-legal markets across the U.S. Through coverage of key market segments including flower via Superflux, vape and concentrates via Jetty, edibles and beverages via Wana, and retail through The Botanist, Canopy USA, LLC is well positioned to accelerate growth with an emphasis on the Midwestern and Northeastern U.S. markets. As newly formed Canopy USA, LLC, we are building a stronger, more agile organization that will unlock greater opportunities across the growing US cannabis market. Who you'll work for: HSCP Service Company LLC Our Culture: Here at Canopy USA, LLC, we believe in people first. We value our people and encourage continuous opportunities to learn, develop, and grow. We pride ourselves in innovation and passion for the cannabis industry. We are always looking for motivated people who share our vision to join our team. Think you have what it takes? Then come grow with us! About the Role: The FP&A team is focused on supporting the firm in achieving its business goals from a financial viewpoint. To that end, the Financial Analyst is responsible for creating financial models, analyzing business results, and delivering insights into the business. Working in partnership with the Director of FP&A, the Financial Analyst will focus on effective business planning, resource allocation, and business performance. How you'll make a difference: * Reporting and analytics involving financials and other key performance indicators critical to operational management of the businesses * Participate and support FP&A projects and drive standardization and improvement of activities to generate efficiency both through logic building and automation * Develop financial models and management reporting packages to support business planning and execution * Participate in the annual budgeting and periodic forecasting processes. * Analyze financial results and provide commentary as required * Collaborate with other departments and cross-functional teams in measuring and analyzing projects and initiatives * Articulate financial concepts to non-finance business partners in a clear and concise manner * Perform other related duties as assigned Skills to be Successful: * Bachelor's degree in Finance, Accounting, or closely related field * Three or more years of relevant experience * Able to operate in a remote working environment * Exceptional verbal and written communication skills * 'Can-do' attitude - willing to contribute at all levels in a small but high performing team environment with strict deadlines and multiple demands * Knowledge of the Cannabis industry or Retail experience is preferred Computers and Technology * Highly proficient in Microsoft Word, Excel, PowerPoint * Experience with NetSuite, Microsoft Dynamics, Power BI, or Domo encouraged Perks & Benefits: * Full suite of medical, dental, and vision insurance * Paid parental leave * 401 (k) * Paid Time Off * Short Term and Long-Term Disability * Employee Assistance Program * Employee life insurance and supplemental life * Spouse and child life and AD&D * Pet insurance * FSA and HSA available * Based on eligibility. Schedule: * Monday-Friday Subject to change as business needs. Work Environment and Physical Demands: The work environment characteristics and physical demands described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be requested to enable individuals with disabilities to perform the essential functions. Manufacturing environment that requires extended time standing, walking, bending and reaching. Ability to carry up to 50lbs for up to a distance of 100ft may be required. Occasional extended and repetitive use of arms, hands and fingers to cut and manipulate small objects. Ability to work in a humid and pollinated environment. E-Verify Participation Notice This Employer participates in E-Verify and will provide the federal government with your Form I-9 information to confirm that you are authorized to work in the U.S. What is E-Verify? E-Verify is an internet-based system that compares information from and employee's Form I-9, Employment Eligibility Verification, to data from the U.S. Department of Homeland Security and Social Security Administration records to confirm employment eligibility. Code of Conduct: All employees are expected to represent the values and maintain the standards contained in the Code of Conduct. HSCP Service Company LLC is an Equal Opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, age, sexual orientation, disability, or protected Veteran status. We appreciate your interest in HSCP Service Company LLC. If you need assistance with completing an online application due to a disability, please send a request to **************************. Please be sure to include "Accommodation Request" in the subject line.

Optiv + ClearShark is looking for a proactive and self-motivated individual, responsible for executing routine tasks outlined in a statement of work with minimal oversight and ensuring adherence to project timelines and deliverables. To be successful in this role, the candidate will maintain and obtain certifications aligned with industry standards to enhance their expertise. They are expected to utilize problem-solving skills to find effective resolutions and to escalate complex issues promptly. Excellent communication skills are essential for this role, as these individuals will interact with clients regularly. How you'll make an impact Have an initial understanding of the most effective and efficient process to get things done with a focus on continuous improvement. Begin to develop the ability to make sense of complex information to effectively solve problems, reaching out to mentors for guidance when necessary. Spend 10% of the time focusing on training and fine-tuning skills. Spend 90% of the time on engagements. What we're looking for Currently holds a Top Secret clearance - TS/SCI with a CI poly required. Experience operating in classified environments. Bachelor's degree in a related area or at least 4 years of related work experience. Understanding of identity, SIEM, cybersecurity, and infrastructure concepts. Strong experience in Splunk, Cribl and Splunk Enterprise Security. Splunk Admin certification is highly desired, Splunk Power User certification required. Understanding of governance and compliance, specifically with FAR, DFARs, CUI and CMMC. Understanding of FedRAMP and IL constructs. Strong interpersonal skills and ability to work collaboratively in a team. Ability to clearly communicate complex messages to a variety of audiences. Excellent problem-solving skills with a keen attention to detail. Willingness to travel to meet client needs. What you can expect from Optiv A company committed to championing Diversity, Equality, and Inclusion through our Employee Resource Groups. Work/life balance Professional training resources Creative problem-solving and the ability to tackle unique, complex projects Volunteer Opportunities. “Optiv Chips In” encourages employees to volunteer and engage with their teams and communities. The ability and technology necessary to productively work remotely/from home (where applicable) EEO Statement Optiv + ClearShark is an equal opportunity employer. All qualified applicants for employment will be considered without regard to race, color, religion, sex, gender identity or expression, sexual orientation, pregnancy, age 40 and over, marital status, genetic information, national origin, status as an individual with a disability, military or veteran status, or any other basis protected by federal, state, or local law. Optiv + ClearShark respects your privacy. By providing your information through this page or applying for a job at Optiv + ClearShark, you acknowledge that Optiv + ClearShark will collect, use, and process your information, which may include personal information and sensitive personal information, in connection with Optiv + ClearShark's selection and recruitment activities. For additional details on how Optiv + ClearShark uses and protects your personal information in the application process, click here to view our Applicant Privacy Notice. If you sign up to receive notifications of job postings, you may unsubscribe at any time.

Affirm is reinventing credit to make it more honest and friendly, giving consumers the flexibility to buy now and pay later without any hidden fees or compounding interest. What You'll Do: Perform advanced data analysis to derive critical insights and develop credit strategies; Utilize data modeling techniques to manage the profitability and resilience of Affirm by assessing and managing risk through analysis and development of portfolio models by using statistics to quantify risk; Collaborate with Data Science and Engineering teams to build our new underwriting models and risk management capabilities for Affirm's consumer finance platform; Explore business data by using statistical and data modeling to develop robust lifetime valuation infrastructure and capabilities; Collaborate with the Merchant Pricing team to value different merchants and use advanced data analytics to derive insights and optimize credit strategies; Develop credit policies for new initiatives and products; Develop effective risk management strategies and capabilities by analyzing business data sets and using Structured Query Language (SQL) to perform ongoing data testing and experimentation; Monitor portfolio as well as macroeconomic trends impacting loan performance; and Improve end-to-end product analytics workflows using quantitative techniques including linear and logistic regression, classification, clustering and other data modeling and mining methods to deeply understand and analyze data that will improve underwriting solutions. May telecommute. Position requires 5% of travel to various unanticipated worksites nationally. What we look for: Master's degree (or foreign equivalent) in Business Analytics, Financial Engineering or related field & one year of experience in the following: Economic and accounting principles and practices, including: the financial markets, banking, and the analysis and reporting of financial data; SQL, Python, R, Matlab, or AWS; Looker or Tableau; Risk modeling including both credit and market risk, assessing macroeconomic trends and financial performance, enabling evaluation of industry risk trends; Using advanced machine learning techniques to develop quantitative models to predict probability of default with financials and macroeconomic indicators; Data analytics, financial modeling, model validation, and risk analytics. Base Pay Grade - K Equity Grade - 4 Employees new to Affirm typically come in at the start of the pay range. Affirm focuses on providing a simple and transparent pay structure which is based on a variety of factors, including location, experience and job-related skills. Base pay is part of a total compensation package that may include equity rewards, monthly stipends for health, wellness and tech spending, and benefits (including 100% subsidized medical coverage, dental and vision for you and your dependents.) USA base pay range (CA, WA, NY, NJ, CT) per year: $140,000-$190,000 USA base pay range (all other U.S. states) per year: $128,398-$174,000 #LI-DNI Affirm is proud to be a remote-first company! The majority of our roles are remote and you can work almost anywhere within the country of employment. Affirmers in proximal roles have the flexibility to work remotely, but will occasionally be required to work out of their assigned Affirm office. A limited number of roles remain office-based due to the nature of their job responsibilities. We're extremely proud to offer competitive benefits that are anchored to our core value of people come first. Some key highlights of our benefits package include: Health care coverage - Affirm covers all premiums for all levels of coverage for you and your dependents Flexible Spending Wallets - generous stipends for spending on Technology, Food, various Lifestyle needs, and family forming expenses Time off - competitive vacation and holiday schedules allowing you to take time off to rest and recharge ESPP - An employee stock purchase plan enabling you to buy shares of Affirm at a discount We believe It's On Us to provide an inclusive interview experience for all, including people with disabilities. We are happy to provide reasonable accommodations to candidates in need of individualized support during the hiring process. [For U.S. positions that could be performed in Los Angeles or San Francisco] Pursuant to the San Francisco Fair Chance Ordinance and Los Angeles Fair Chance Initiative for Hiring Ordinance, Affirm will consider for employment qualified applicants with arrest and conviction records. By clicking "Submit Application," you acknowledge that you have read Affirm's Global Candidate Privacy Notice and hereby freely and unambiguously give informed consent to the collection, processing, use, and storage of your personal information as described therein.

Responsible for maintaining a full time on site Condition Monitoring services ensuring quality and customer satisfaction. Candidate is responsible for scheduling work as necessary as well as reporting metrics, KPIs that accurately reflect the performance, progress, reports and findings as required by the client and I-care. The Manager is also accountable for developing and updating SOP's, internal audits, overall safety, including ensuring compliance with all I-care, client, OSHA, and all other applicable standards to the facility that they are servicing, be a technical resource to the client and I-care employees in troubleshooting PdM and lubrication-related issues and perform and oversee specific projects as assigned. ESSENTIAL FUNCTIONS AND BASIC DUTIES 1. Leads condition monitoring program setup or for clients as required, including but not limited to: a. Building and maintaining CM technology databases to applicable I-care and client-required standards. 2. Responsible for communication and education between the company and clients, including but not limited to: a. Communicating the I-care deliverables to the client. b. Conduct technology awareness sessions for clients as requested. c. Submit documented case studies for customers to support machine life cycle improvement. d. Must be able to interact comfortably, gain trust, and communicate effectively. 3. Responsible for necessary auditing, metrics and reporting, including but not limited to: a. Ensuring all databases are in compliance with current applicable standards. b. Managing all database changes. c. Lead Management of Change (MOC) process adherence. e. The accuracy and timeliness of all internal and external communications and reporting. f. Nuisance alarm management. 4. Responsible for the overall safety awareness of the work environment. a. Ensuring compliance with I-care, client, OSHA, and other applicable standards. b. Actively participates in I-Care and client safety programs to foster continuous improvement. c. Issue a “Stop Work” action if any situation, environment, or condition is an immediate concern of injury to himself or others. If it is not safe then do not perform the work until a safe method or condition exists, period. 5. Mentoring - A few of the activities in the area of Mentoring will include, but are not limited to: a. Assist in training/mentoring of I-Care employees. b. Able to convey obtained knowledge from seminar/training sessions. 6. Performs Condition Monitoring and Reporting of equipment. Condition Monitoring responsibilities include but are not limited to: a. Collect technology data in accordance with I-Care and best practice industry standards. b. Maintains technology databases with current information. e. Reports results in a clear concise manner following all I-Care and/or client procedures for content. 7. Other Responsibility a. Performs special projects as assigned. Work on call and/or overtime as needed and required. b. Ensures that the work area and all I-Care and/or client-supplied equipment are clean, secure, and well maintained. _______________________________________________________________________________________ GENERAL PERFORMANCE MEASUREMENTS 1. Technical - verifies accurate analysis and reporting of technology data, reports are accurate, and neat, and assignments are completed as scheduled. 2. All inquiries are courteously attended to. Good business relations exist with I-Care employees and clients. A professional image is projected at all times. 3. Work is performed safely and the employee actively participates in continuous improvement of the safety programs. Work areas and equipment are kept neat, clean, and well organized. QUALIFICATIONS EDUCATION/CERTIFICATION: High school graduate or equivalent, College Graduate preferred in technology or engineering field. ASNT-TC1A or ASNT-CP189 Professional Certification Level 2, or ISO Category 3, or industry equivalent. REQUIRED KNOWLEDGE: Mechanical CM Analyst: machinery fundamentals including pumps, motors, gearboxes, blowers, compressors, switchgear, etc. Knowledge of mechanical fundamentals, such as fits and tolerances. Detailed knowledge of data acquisition techniques utilizing Vibration Analyzers, Ultrasound. Working knowledge of other condition-monitoring technologies. Electrical CM Analyst: knowledge of electrical fundamentals including: switchgear, fuses, disconnects, cable, torquing of fasteners, transformers, etc. Knowledge of data acquisition techniques utilizing Infrared Cameras, Ultrasound, Motor Testing Equipment. Working knowledge of other condition-monitoring technologies. EXPERIENCE REQUIRED:3 or more years of direct related experience. SKILLS/ABILITIES: Good communication skills, both oral and written. Proficient computer skills, including but not limited to Windows, Word, and Excel. Solid analytical and problem-solving abilities. Able to work well independently.

Discover the feelings of Camaraderie and Family while being analytically and technically challenged to grow! Responsibilities: Collaborate directly with clients' end-users and our internal teams to design and develop dynamic Enterprise Web and Mobile applications in Cyber Security, Supply Chain/Logistics, or Finance for a variety of clients like Verizon, Capital One, and Cardinal Health in small teams. Work in a fast-paced, hands-on capacity in a client-interactive role, rapidly absorbing and analyzing requirements, creating use cases and business applications requirements seeing first-hand the impact of your work on a daily basis. Desired Skills/Traits: Understanding/familiarity with software/technology, Proficiency or ability to quickly learn new concepts and technologies. High Energy / Attitude. Creative Problem Solving. We take care of our EAI Family: FREE catered lunch DAILY. Stipend provided during COVID work from home. Paid Training (CodeAcademy, Coursera, NoFluffJustStuff, Google DevFest, pre-paid courses, mentoring). FREE snacks/drinks - Multiple varieties of soft drinks, juices, coffee, tea, Gatorade, beer, wine & regular social gatherings. EAI has NEVER HAD LAYOFFS from its beginnings in 2001. We have carried our folks through multiple tough economic cycles (2002, 2009/10, current pandemic) and will continue to do so! We are growing and looking for individuals who want to be part of a fun, passionate, and highly accomplished team with Hackathons and regular events like Poker and Movie Night to keep the spirits alive. Combine that with daily catered lunch from such restaurants as Cava, Chipotle, La Plaka, Jason's Deli, and Shake Shack and you can see that we strive to foster a family-friendly culture that emphasizes teamwork, camaraderie, and openness. Come experience why so many employees have been with EAI for 5 to 10+ years and continue to make it their home as the EAI Family expands.

The Payment Cycle Analyst III is responsible for conducting both systemic and targeted analysis to identify reimbursement errors and to determine root cause. As well as collaborating with Configuration, Configuration UAT, Enterprise UAT, IT Claims, and Payment Cycle Team members to ensure test scripts are comprehensive. Essential Functions: Provide analytical support and leadership for special projects and initiatives related to reimbursement of claims for both providers and members Research and provide recommendations to the Reimbursement Committee for reimbursement of services Research claim results to determine potential errors/discrepancies attributed to clinical edits, claims coding, payment policies, and application of fee schedule and rates Develop business requirements for payment decisions and manage the implementation process with Configuration, CES, IT and Market stakeholders Lead special projects to ensure payment discrepancies are resolved and communicated to the appropriate parties Provide payment expertise at provider meetings, Medicaid Fairs, market workgroups, and any other industry related events Review and interpret regulatory items and policy manuals to ensure test scenarios support the requirements Identify test result outputs and Claim SOPs that need to be modified or created to support new or changed business requirements Build library of re-usable tests plans & scripts to support the Market Document the status of test results and gaps in testing for future improvements Validate Impact Reports to ensure the criteria is consistent with story and universe of claims impacted by the changes Approve UAT test scripts and test results prior to promoting changes to production and monitor post production results Validate MCA Tests for expected results and communicate information to Reimbursement Analysts and HP Managers for provider notification Conduct both systemic and targeted analysis to identify issues with testing and identify process changes for improvement Create effective written and oral communication materials that summarize findings and support fact based recommendations that can be shared with Configuration, IT, UAT, Reimbursement Committee, Payment Cycle, and Provider Groups Perform any other job duties as requested Education and Experience: Bachelor's degree or equivalent years of relevant work experience is required Minimum of five (5) years of health plan experience is required or equivalent experience with health plan operations and configuration Experience with user testing is required Experience with payment methodologies and industry pricers (ex: DRG, APC, SNF, RBRVS) is preferred Competencies, Knowledge and Skills: Advanced proficiency level experience in Microsoft Suite to include Word, Excel, PowerPoint, Access and Visio Strong computer skills and abilities in Facets or equivalent claim payment system is preferred Strong analytical skills with the ability to effectively communicate findings with the Leadership Team Demonstrated understanding of claims operations, configuration, and testing related to managed care Understanding of regression, unit, and user acceptance testing is required Effective listening and critical thinking skills Effective problem-solving skills with attention to detail Creative thinking to develop positive and negative test scenarios Excellent written and verbal communication skills Ability to work independently and within a team environment Strong interpersonal skills and high level of professionalism Ability to develop, prioritize and accomplish goals Understanding of the healthcare field and knowledge of Medicaid, Medicare, and Marketplace Strong working knowledge of claims processing edits and logic Familiar with CMS guidelines / HIPPA and Affordable Care Act Licensure and Certification: None Working Conditions: General office environment; may be required to sit or stand for extended periods of time Compensation Range: $70,800.00 - $113,200.00 CareSource takes into consideration a combination of a candidate's education, training, and experience as well as the position's scope and complexity, the discretion and latitude required for the role, and other external and internal data when establishing a salary level. In addition to base compensation, you may qualify for a bonus tied to company and individual performance. We are highly invested in every employee's total well-being and offer a substantial and comprehensive total rewards package. Compensation Type (hourly/salary): Salary Organization Level Competencies Fostering a Collaborative Workplace Culture Cultivate Partnerships Develop Self and Others Drive Execution Influence Others Pursue Personal Excellence Understand the Business This is not all inclusive. CareSource reserves the right to amend this job description at any time. CareSource is an Equal Opportunity Employer. We are dedicated to fostering an environment of belonging that welcomes and supports individuals of all backgrounds.#LI-TS1

Plan, design, develop, and launch efficient business and operations systems in support of core organizational functions and business processes. Gather and analyze data in support of business cases, proposed projects, and systems requirements. Perform work with a high degree of latitude and handles more complex client accounts and/or configuration issues. Partner with decision makers, systems owners, and end users to define business, financial, and operations requirements and systems goals, identify and resolve systems issues, drive new projects and initiatives, and support existing business dependency. Develop standards, procedures, and design documents related to system architecture. Lead internal teams and IT to gather business requirements needed for system modifications, enhancements, and implementations. Analyze results of user testing to define interface requirements and develop specifications or prototypes. Develop, design, and edit interface templates or interface code, following established software development and methodologies. Serve as the subject matter expert (SME) to identify, create, and facilitate process design changes through the review and analysis of system effectiveness and efficiency; ensure data is reliable and develop strategies for improving and leveraging these systems. Troubleshoot technical issues and lead technical investigations to identify and discover system errors, application modification, and/or functionality related issues. Determine priority of escalated issues effectively and manage conflicting/competing priorities. Perform in-depth tests, utilizing end-user reviews, for modified and new systems and other post-implementation support. Lead and participate in Sprints for development cycle, define deliverables, determine improvement priorities, and provide feedback to ensure on-time delivery of project tasks and milestones. Education Required: Bachelor's degree in Computer Science or related discipline. Or, any combination of education and experience which would provide the required qualifications for the position. Experience Required: 5+ years' experience in using and implementing enterprise application solutions. 5+ years' experience in enterprise application configuration and development. Salesforce platform experience. Oracle CPQ (Big Machines) or similar type of application. Agile environment. Experience designing and supporting large-scale technically complex solutions. Knowledge, Skills & Abilities: Knowledge of: Salesforce configuration and portals including but not limited to developing custom objects, work-flow business rules, and validation rules; Sarbanes Oxley (SOX) processes and Stock Keeping Unit (SKU) creation and modification processes; relational databases used at enterprise scale; Microsoft Office Suite. Skill in: Effective relationship management, communication, and presentation; dealing effectively with customers, vendors, peers, and senior management; work in a fast-paced environment; staying organized, prioritizing workload, multi-tasking, and meeting deadlines. Ability to: Provide orientation and training to end users; mentor and provide guidance to junior staff; work independently as a self-starter in a fast-paced environment; adapt to growing and changing environment delivering accuracy while managing multiple deliverables within a projected timeline. The company has reviewed this to ensure that essential functions and basic duties have been included. It is intended to provide guidelines for job expectations and the employee's ability to perform the position described. It is not intended to be construed as an exhaustive list of all functions, responsibilities, skills and abilities. Additional functions and requirements may be assigned by supervisors as deemed appropriate. This document does not represent a contract of employment, and the company reserves the right to change this job description and/or assign tasks for the employee to perform, as the company may deem appropriate. NextGen Healthcare is an equal opportunity employer. We celebrate diversity and are committed to creating an inclusive environment for all employees.

This role will serve as support for CODISCOVR requests and provide technical support in processing, filtering, ESI imports, load file manipulation, advanced search queries, STRs and culling measures and database design for various eDiscovery and Practice/Litigation Support tools. Note: This is a US-based remote role. Minimum of Bachelor's degree and/or at least 2 years of relevant experience in eDiscovery or technical litigation support at either a Law Firm or Service Provider. Ability to effectively manage technical and quality issues with eDiscovery and litigation support providers. Excellent team work skills and strong client-service orientation. Working knowledge of Relativity. Understanding of other standard law firm applications. Excellent communication skills and the ability to build effective internal and external client relationships. The ability to work concurrently on projects and flexibility in shifting focus. The ability to work under minimal supervision and meet case-specific deadlines. Occasional travel may be required. Provides regular and timely updates of all assigned projects and is expected to work outside regular business hours to adequately complete tasks as needed or directed by the case team or Department Manager. Troubleshoots and provides support specific to litigation support applications and associated technologies to end-users. Culls, filters and de-duplicates raw data for document review. Creates and manipulates load files for various applications. Processes eDiscovery for attorney review in Relativity. Creates transcript management databases per client requests in TextMap and provide support when needed. Manages the secure and stable transfer of client data. Executes client data productions as requested by case team. Provides technical support and training to attorneys, paralegals and other team members across the Firm's offices. Communicates regularly and proactively with case teams to assess goals and set realistic expectations throughout the eDiscovery process including identification, preservation, collection, processing, analysis, review and production of ESI and paper documents. Provides status reports and training to legal teams as needed. Creates database/project structure used including Relativity. Forges collaborative partnerships among the legal teams, the CODISCOVR Department, and throughout all offices. Tracks all case-related activity utilizing project management tools and completes all relevant tracking forms. Contributes to and enriches the knowledge base and expertise of the CODISCOVR Department as a whole. Performs any and all duties as assigned by CODISCOVR Management in compliance with SOPs.