Top 615 work from home Jobs in alda ne

Lead Overpayment Recovery Analyst, Payment Integrity - Health Plan (Remote)
Molina Healthcare, Inc. —Grand Island, NE
- $83,252 - $155,508 a year
- Full-time
- Remote
- Organizational skills
- Senior level
- 2 years
- Health insurance
12d
Licensed Clinical Social Worker
Headway —Nebraska
- Up to $141.32 an hour
- Remote
- Private practice
- Licensed Clinical Social Worker
- Mid-level
Licensed Professional Counselor
Headway —Nebraska
- Up to $141.32 an hour
- Remote
- Private practice
- Master's degree
- Senior level
Licensed Clinical Psychologist
Headway —Nebraska
- Up to $184.81 an hour
- Remote
- Private practice
- Master's degree
- Psychology
Senior Farm Marketing Underwriter
Nodak Insurance Company —Nebraska
- Full-time
- Remote
- Background check
- Up to 50% travel
- Customer service
- Disability insurance
- Health insurance
Licensed Mental Health Therapist
Headway —Nebraska
- Up to $141.32 an hour
- Remote
- Private practice
- LMFT
- Licensed Clinical Social Worker
Licensed Psychiatric Mental Health Nurse Practitioner
Headway —Nebraska
- Up to $216 an hour
- Full-time
- Remote
- Private practice
- Psychiatry
- Mid-level
Licensed Property & Casualty Insurance Agent
Vivian Clough Agency —Nebraska
- $52,268.78 - $100,000.00 a year
- Urgently hiring
- Remote
- Background check
- Customer service
- Communication skills
- Paid time off
- Work from home
Quick Apply
Xtime Regional Sales Manager
Cox Automotive —Nebraska
- $78,500 - $117,700 a year
- Full-time
- Remote
- Dealership
- Customer service
- Finance
- Paid jury duty
- Paid holidays
Health Plan Provider Relations Manager (Remote, Must Reside in NE)
Molina Healthcare —Grand Island, NE
- $57,394.00 - $117,808.76 a year
- Full-time
- Remote
- 6 years
- Mid-level
- Presentation skills
- Health insurance
Risk & Quality Reporting Analyst (Must have SQL, PowerBi, Databricks, Managed Care) - REMOTE
Molina Healthcare —Grand Island, NE
- $47,433.00 - $97,362.61 a year
- Full-time
- Remote
- Microsoft Excel
- Azure
- Research
- Health insurance
Remote Commission-based Sales Specialist - Insurance
Emergent Financial Group —Grand Island, NE
- $40,000 - $400,000 a year
- Part-time
- Remote
- Computer literacy
- Communication skills
- Entry level
- Opportunities for advancement
Quick Apply
(RN) Remote Care Manager - CA License req
Molina Healthcare, Inc. —Grand Island, NE
- $30.37 - $61.79 an hour
- Full-time
- Remote
- Bilingual
- RN License
- HIPAA
- Health insurance
13d
Account Executive
Great Plains Communications —Grand Island, NE
- Remote
- 5 years
- Driver's License
- Bachelor's degree
Quick Apply
Crop Protection Sales Representative
Syngenta Crop Protection —Grand Island, NE
- Full-time
- Remote
- Marketing
- Mid-level
- Driver's License
- Profit sharing
- Paid parental leave
Quick Apply
Senior Cyber eDiscovery Consultant
Cognicion, LLC —United States
- $95,600 - $145,400 a year
- Full-time
- Remote
- Background check
- Mid-level
- Bachelor's degree
- Health savings account
- Health insurance
Cyber eDiscovery Specialist
Cognicion, LLC —United States
- $95,600 - $145,400 a year
- Full-time
- Remote
- Background check
- SQL
- Bachelor's degree
- Health savings account
- Health insurance
Remote Physician (MD/DO), PMR or Neurology, Outpatient Prior Authorizations (REMOTE/FT) (IC to FTE)
Virtix Health —United States
- $125 an hour
- 8 hour shift
- Remote
- Background check
- Medicine
- Doctoral degree
- Work from home
Quick Apply
Removal Immigration Attorney
Confidential —United States
- From $150,000 a year
- Full-time
- Remote
- Writing skills
- 11+ years
- Administrative experience
Quick Apply
Licensed Clinical Social Worker (Collaborative Weight Loss)
Ilant Health —United States
- $70,000 - $90,000 a year
- Full-time
- Remote
- Management
- Surgery
- Licensed Clinical Social Worker
- Health insurance
- Dental insurance
Quick Apply

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work from home jobs near alda ne

Lead Overpayment Recovery Analyst, Payment Integrity - Health Plan (Remote)

Molina Healthcare, Inc. -
Grand Island, NE

Apply Now

Job Details

Full-time
$83,252 - $155,508 a year
12 days ago

Benefits

Health insurance

Qualifications

Medical claims processing
Managed care
Medicare coding guidelines
Managed care organization experience
Spreadsheets
Regulatory compliance in claims processing
Health insurance knowledge
Project management in healthcare
Centers for Medicare & Medicaid Services (CMS) billing regulations
Managing projects
Productivity software
Cross-functional collaboration
Financial data analysis tools
Cross-functional communication
Data analysis software

Full Job Description

JOB DESCRIPTION Job Summary

Provides lead level analyst support for health plan payment integrity activities. Partners with leaders and functional representatives to drive health plan financial performance through evaluation and execution of operational initiatives tied to payment integrity (PI) and provider claims accuracy. Makes recommendations that inform decisions which contribute to health plan strategy, and acts as a trusted voice in assessing and assisting resolution of complex business challenges that impact cost-containment and regulatory compliance.

Essential Job Duties

Business Leadership & Operational Ownership
Assists with and executes projects and tasks to ensure Centers for Medicare and Medicaid Services (CMS) and state regulatory requirements are met for pre-pay edits, post-payment datamining, and overpayment recovery, to improve encounter submissions, reduce general and administrative (G&A) expenses, and drive positive operational and financial outcomes for all payment integrity (PI) solutions.
Manages scorable action items (SAIs) related to pre-pay editing, post-pay audit, and overpayment recovery initiatives to ensure health plan SAI targets are met.
Leads efforts to improve claim payment accuracy and financial performance without needing extensive oversight.
Collaborates with operational teams, enterprise stakeholders, and finance partners to proactively identify issues and implement resolution strategies.
Serves as a thought partner to health plan leadership and provides well-reasoned recommendations that support short- and long-term business goals.
Partners with the network team to communicate recovery projects to ensure provider relations is informed and able to respond to provider inquiries.

Analyze data to identify and develop new recovery opportunities
- Analyze data from Payment Integrity and Vendors against contracts, billing, and processing guidelines
- Collaborates with operational teams, enterprise stakeholders, and finance partners to proactively identify issues and implement resolution strategies.
- Conduct peer reviews of recovery concepts and offer recommendations for logical improvements; assist team members in their analysis of data sets and trends.
Responsible for documenting policies and procedures related to concept approvals
- Conduct trainings and prepare training documentation for teams
- Other duties as assigned

Strategic Business Analysis

Uses a business lens to ensure accurate interpretation of provider claims trends, payment integrity issues, and process gaps.
Applies understanding of health care regulations, managed care claims workflows, and provider reimbursement models to shape payment integrity related recommendations and action plans.
Translates strategic needs into clear requirements, workflows, and solutions that drive measurable improvement.
Partners with finance and compliance to develop business cases and support reporting that ties operational outcomes to financial targets.

Applied Analytical Support
Uses data analysis tools/systems to support business analysis.
Validates findings and tests assumptions through data, and leads with contextual knowledge of claims processing, provider contracts, and operational realities.
Creates succinct summaries and visualizations that enable faster leadership decision-making.

Required Qualifications

At least 4 years of business analyst experience in a managed care organization (MCO), and at least 2 years of experience in Medicaid and/or Medicare programs, or equivalent combination of relevant education and experience.
Proven experience owning operational projects from concept to execution, especially in the areas of provider reimbursement and claims payment integrity.
Strong working knowledge of managed care claims coding (Current Procedural Terminology (CPT), International Classification of Diseases (ICD), Healthcare Common Procedure Coding System (HCPCS), Revenue Codes), and federal/state Medicaid payment rules.
Strong data analysis/queries experience, and ability to analyze data to inform business decisions.
Strong business judgment, cross-functional coordination, and ownership of high-value deliverables.
Demonstrated ability to work independently and apply business judgment in a highly regulated, cross-functional environment.
Strong written and verbal communication skills, including ability to synthesize complex information.
Microsoft Office suite (including advanced Excel), and applicable software program(s) proficiency.

Claims processing background
Experience with Medicare, Medicaid, and/or Marketplace lines of business.

Preferred Qualifications

Experience with Medicare, Medicaid, and/or Marketplace lines of business.
Certified Business Analysis Professional (CBAP) or Certified Coding Specialist (CCS) certification.
Project management experience.
Familiarity with Medicaid-specific scorable action items (SAIs), operational cost-management efforts, payment integrity (PI) programs, and regulatory/compliance adherence.

To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board.

Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V

Apply Now

Refine Your Search

work from home jobs in alda ne

Lead Overpayment Recovery Analyst, Payment Integrity - Health Plan (Remote)

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