The Senior Data Analyst will support the development of a Claims Reconciliation Hub by defining matching criteria between pre-service estimates and actual medical claims. They will analyze complex claims data across multiple platforms to identify patterns, relationships, and reconciliation opportunities.
Assist with campaigns and outreach for New England CDOs using Epic Cheers and CRM. Provide consulting services to optimize patient outreach and engagement workflows.
The role involves designing and developing clinical and business interfaces within Epic and Oracle Health EMRs. Responsibilities include translating business requirements into functional specifications and maintaining system documentation.
Conduct clinical reviews of claims and utilization management authorization requests to determine clinical necessity. Perform reviews specifically for emergency department and internal medicine cases.
Manage various clinical product categories and lead value analysis presentations and product evaluations across service lines. Negotiate with vendors and support the project manager in developing and tracking the savings pipeline.
The analyst is responsible for the build and support of Epic Tapestry Utilization Management, specifically focusing on authorizations and referrals. They will configure routing rules, workqueues, and decisioning tools while managing operational reporting for UM KPIs.
Manage and optimize specialized laboratory supply chains, focusing on reagent and analyzer contracts and reference lab agreements. Analyze platform consolidation and utilization across multiple hospitals to drive cost-efficiency and standardization.
Lead sourcing and contract negotiations for non-clinical categories including purchased services, facilities, and IT. Manage support staff and present savings recommendations to leadership and Value Analysis Committees.
Manage high-dollar clinical supply categories including implants and cardiovascular devices while negotiating pricing with vendors. Lead value analysis and product evaluations to drive standardization and cost savings across OR and Cath Lab environments.
The role involves leading executive governance meetings and steering committees while managing savings targets and budgets. Additionally, the manager will perform hands-on sourcing work, including RFPs and negotiations across clinical and non-clinical categories.
Manage high-volume med/surg consumables and lead nursing-focused value analysis initiatives to drive product standardization. Negotiate pricing for consumable contracts and collaborate with CNOs and nursing directors to optimize clinical supplies.
The Sr. Quality Analyst ensures the accuracy and integrity of workflows within the Medicare & Retirement Program Orchestration organization. This includes enforcing quality management plans, performing QA/QC validation, and supporting audit readiness through detailed documentation.
Design and implement NLP and LLM-driven pipelines to extract regulatory logic and rules from complex CMS documentation. Develop and productionize automated workflows using Python and enterprise tools like UiPath and Power Automate.
Facilitate Agile ceremonies and guide the team through planning, execution, and reflection to ensure consistent delivery. Collaborate with Product Owners and Release Train Engineers to manage backlogs and align objectives across the Agile Release Train.
The role involves performing expert hands-on configuration within various Facets applications including System Administration, Security, and NetworX. The analyst is responsible for managing provider, membership, and claims processes while coordinating with upstream and downstream systems.
The Technical Analyst supports the analysis, design, and operational stability of healthcare systems on the Cognizant Facets platform. They act as a technical liaison to translate business requirements into technical solutions and support AWS-based deployments.
The analyst is responsible for the benefit and authorization configuration within the Health Rules Payor platform. This includes managing referral category configurations and utilizing SQL queries to interact with HR Payer tables.
The role is responsible for supporting, managing, and optimizing Identity and Access Management operations. Key duties include leading the design and implementation of complex IAM systems and onboarding applications to platforms like SailPoint, Okta, and CyberArk.
Design and build production-grade LLM-powered applications and agentic workflows using Python. Implement RAG pipelines and integrate AI systems with backend services and cloud platforms.
The role involves managing Windows systems and handling vulnerability management. Responsibilities include GPO administration and the creation and deployment of software packages.
Lead automation engineers in testing pharmacy projects and oversee the design of enterprise-wide quality management strategies. Direct the implementation of testing strategies for large programs and customize methodologies to support business processes.
Build and maintain a legacy claim auditing system while ensuring solutions align with current architecture and future enhancements. Modify existing programs to new standards and create migration packages for testing and implementation.
The consultant will focus on managing network security and identity access across cloud environments. Responsibilities include performing vulnerability assessments and resolving security issues.
The role involves deploying and managing Dell EMC enterprise storage platforms, specifically focusing on NAS and Object Storage. Responsibilities include configuring protocols, managing geo-replication, and analyzing system performance metrics.
Build, configure, and provide Tier 2 support for a variety of security tools including SIEM, WAF, and endpoint protection. Partner with SOC and IT teams to improve operational efficiency and assist in the investigation and remediation of security incidents.
Conduct an audit of client coding and charges to improve reimbursement. Maintain the chargemaster for home health and hospice services.
The role involves managing SHIP-specific test data across various environments and executing testing for key capabilities. Additionally, the candidate will lead defect management and VOC monitoring to ensure delivery stability.
The role involves performing HIM analysis utilizing Epic software. The analyst will manage identity and request of information processes within the healthcare system.
Build and optimize business and IT processes to reduce turnaround time and improve delivery. Oversee a portfolio of improvements, implement quality controls, and facilitate root cause analysis based on metrics.
Leads workshops to create conceptual architecture flows and works with Product Owners to define user stories and storyboards. Responsible for leading internal testing and assisting in the acceptance of user stories.
Implement PHC Home Health optimization and enhancement tickets. Advise on alternate technical solutions when the primary suggested path is not feasible.
The analyst will manage and optimize Epic Patient Access functions. This includes working with Cadence, referrals, and decision tree configurations.
The analyst will provide design, build, and testing expertise for the Epic Healthy Planet module, collaborating with end users to enhance system workflows. Responsibilities include leading software upgrades, performing daily production monitoring, and providing 24/7 on-call support for application incidents.
Develop and maintain complex workflows using Alteryx and IBM Unica to support Medicare and STARS program orchestration. Act as a technical lead to translate business strategies into system architecture and manage data solutions across various platforms.
The analyst is responsible for the configuration, implementation, and design of Epic Prelude and Referrals modules. They will also handle requirements gathering, testing, deployment, and cross-team collaboration to drive process improvements.
The role involves managing Windows Server environments with a focus on scripting and automation. The professional will be responsible for Epic ECSA related system administration tasks.
The role involves serving as an Epic Caché Database Administrator. The primary focus is managing database operations within a Linux environment.
Lead the requirements gathering, system design, and implementation of Epic Ambulatory solutions. Collaborate across application teams to support testing, deployment, and the mentorship of junior analysts.
The Business Analyst will gather and document requirements from CMS regulatory documentation and support client discovery sessions. They will also create workflows, deliverables, and assist the Product Owner with user acceptance criteria and feature writing.
The role involves defining, documenting, and executing test cases in Jira based on requirements. Responsibilities include running SQL queries for analysis and researching claim outcome discrepancies between systems.
The analyst is responsible for product build and NetworX configuration within the Facets module. They will manage core functionalities including membership, provider management, claims, and billing.
Design, develop, and support healthcare systems built on the Cognizant Facets platform. Deliver integrations, extensions, and cloud-based solutions within AWS environments to support core healthcare operations.
The IT Project Management Advisor develops and manages project assignments from inception to completion while communicating progress to stakeholders. They are also responsible for analyzing statistical data, resolving client issues, and providing training to management and colleagues.
The consultant will design, develop, and implement scalable CRM solutions using Dynamics 365 and Power Platform tools. They will collaborate with technical and business teams to deliver high-quality solutions across multiple workstreams.
The Claims Examiner analyzes and manages complex workers' compensation claims, including investigating exposure, calculating reserves, and negotiating settlements. They also coordinate vendor referrals, manage litigation, and ensure compliance with statutory requirements and client service expectations.
