Patient Claims Analytics Manager Job at Amgen (Hyderabad)

Senior Manager of Business Intelligence

As a Senior Manager of Business Intelligence for the Quality zone, you will be a...

Location

United States , Bethesda

Salary:

Not provided

Aledade, Inc.

Expiration Date

Until further notice

Requirements

10+ years of experience in business intelligence
3+ years of managerial experience
Deep expertise in healthcare quality measurement, with a strong understanding of frameworks such as NQF, eCQMs, MA STARs, HEDIS, and MIPS
Proven track record of partnering with senior and executive-level stakeholders to translate complex clinical/quality business needs into a strategic, actionable analytics roadmap
Specific experience managing or overseeing MSSP Quality Reporting and MA STARs performance data
Expert-level proficiency in SQL and deep, hands-on experience with a modern data stack, including Snowflake for data warehousing, dbt for data transformation, and Tableau for data visualization
Extensive experience analyzing complex healthcare data (e.g., medical claims, EHR, clinical registries) within a value-based care framework
Exceptional communication and storytelling skills, with the ability to distill complex analytical findings into clear, actionable insights for a wide range of audiences, including executive leadership
Expertise in data warehousing principles and scalable data modeling concepts to build robust, foundational data solutions
Proven ability to lead an analytics team within an agile framework, effectively managing team sprints, backlogs, and project roadmaps

Job Responsibility

Drive Strategic Impact (25%): Act as a key strategic partner to senior leaders within the Quality and Clinical domains. Translate evolving regulatory and clinical needs into a clear technical roadmap, delivering analytics that measure MSSP and MA STARs performance, demonstrate clinical value, and drive patient health outcomes
Develop & Mentor Your Team (25%): Manage, coach, and develop a high-performing team of individual contributors, including leads and senior analysts. Foster a respectful and supportive environment where team members can grow, providing regular feedback, career mentorship, and opportunities for development
Champion Excellence & Collaboration (20%): Lead your team in agile processes, anticipating and mitigating roadblocks. Promote a "one team" mentality through cross-functional partnership, ensuring tight alignment with Payer & Network BI Zones to ensure Data for Good measures (e.g., diabetes care) are integrated into broader company performance views
Own the BI Vision & Roadmap (15%): Take full ownership of the BI roadmap and quarterly planning for the Quality domain. Work closely with key stakeholders on strategy, demand management, and prioritization to ensure the team is delivering the most valuable data products for regulatory reporting and clinical improvement
Deliver Actionable Insights (15%): Oversee the development of interactive dashboards, executive-level reports, and presentations that clearly communicate insights on Quality measurement, gap-closure opportunities, and the efficacy of clinical programs

What we offer

Flexible work schedules and the ability to work remotely are available for many roles
Health, dental and vision insurance paid up to 80% for employees, dependents and domestic partners
Robust time-off plan (21 days of PTO in your first year)
Two paid volunteer days and 11 paid holidays
12 weeks paid parental leave for all new parents
Six weeks paid sabbatical after six years of service
Educational Assistant Program and Clinical Employee Reimbursement Program
401(k) with up to 4% match
Stock options

Fulltime

Manager, Revenue Cycle Management

The Manager, Revenue Cycle Management (RCM) will build, lead, and scale the RCM ...

Location

United States

Salary:

111012.00 - 133215.00 USD / Year

Babylist

Expiration Date

Until further notice

Requirements

7+ years of experience in healthcare revenue cycle management
At least 5 years managing RCM or billing operations teams
Proven expertise in DME billing and payer management including claims submission, denial analysis, appeals, and reimbursement workflows
Deep knowledge of insurance provider requirements, EDI file types, and compliance frameworks (HIPAA, CMS)
Experience implementing or optimizing RCM systems such as Brightree, Niko Health, or similar DME billing software
Data-driven leader with strong analytical and process improvement skills
Proficient with Excel and/or BI reporting tools
Exceptional communicator who can translate technical billing issues into cross-functional strategies
Collaborative, hands-on leader who inspires trust, accountability, and performance across distributed teams
Strong operational discipline with the ability to establish SLAs, observability metrics, and scalable processes

Job Responsibility

Lead end-to-end revenue cycle operations including charge entry, claims submission, payment posting, denial management, and AR follow-up
Establish quality controls, monitor key metrics (days in AR, denial rates, clean claim rates), and prevent backlogs to ensure timely reimbursements within filing deadlines
Build, manage, and develop a high-performing team of RCM professionals
Create a culture of accountability and continuous improvement through clear goals, mentorship, and data-driven decision-making
Serve as the primary point of contact and voice of Babylist with key insurance providers and partners
Develop and implement scalable workflows for claims management, payer recoupments, and patient billing
Ensure compliance with regulatory requirements (HIPAA, CMS) and optimize EDI performance through clearinghouses and payer portals
Partner cross-functionally with Finance, Product, Engineering, Clinical Operations, and Customer Support to forecast cash flow, identify revenue opportunities, and design automated tools
Drive the adoption of technology and AI to automate routine processes, improve claims accuracy, and build scalable systems
Establish operational mechanisms, SLAs, and observability metrics to build a disciplined, scalable foundation for growth

What we offer

Competitive salary with equity and bonus opportunities
Company-paid medical, dental, and vision insurance
Retirement savings plan with company matching and flexible spending accounts
Generous paid parental leave and PTO
Remote work stipend to set up your office
Perks for physical, mental, and emotional health, parenting, childcare, and financial planning

Fulltime

Medical Billing Specialist

We are seeking a dedicated and detail-oriented Medical Billing Specialist to joi...

Location

United States , Hagerstown

Salary:

Not provided

Robert Half

Expiration Date

Until further notice

Requirements

High school diploma or equivalent
Associate’s degree in Health Information Technology, Business Administration, or a related field is preferred
1+ years of experience in medical billing and accounts receivable, preferably within a healthcare setting
Strong knowledge of medical terminology, coding systems (CPT, ICD-10, HCPCS), and insurance regulations
Experience with medical billing software and electronic health records (EHR) systems
Excellent communication skills, both verbal and written
Detail-oriented with strong organizational and analytical skills
Ability to manage multiple priorities and meet deadlines in a fast-paced environment
Knowledge of HIPAA regulations and confidentiality requirements

Job Responsibility

Billing & Coding: Accurately review and submit medical claims to insurance companies, government programs (e.g., Medicare, Medicaid), and patients based on services provided
Accounts Receivable Management: Monitor and follow up on unpaid claims and accounts, ensuring timely resolution and payment collection
Claim Denial Management: Investigate and resolve denied or rejected claims, working with insurance providers to rectify issues and ensure proper reimbursement
Payment Posting: Post payments, adjustments, and denials to patient accounts accurately
Patient Communication: Communicate with patients and insurance companies to resolve billing inquiries, provide payment information, and answer any questions related to their accounts
Account Reconciliation: Ensure all accounts are reconciled and balanced, identifying discrepancies and making necessary adjustments
Compliance: Maintain up-to-date knowledge of relevant billing codes, insurance policies, and regulations to ensure compliance with industry standards and government regulations
Reporting: Generate and review accounts receivable reports, aging reports, and other billing data to ensure financial goals are met and identify areas for improvement
Collaboration: Work closely with the clinical and administrative teams to resolve any billing issues, discrepancies, or concerns

What we offer

Medical, vision, dental, and life and disability insurance
Company 401(k) plan
Access to top jobs
Competitive compensation

Fulltime

Systems Director, Population Health Service Organizations

The System Director of IT Population Health Services Organization (PHSO) is a le...

Location

United States , Phoenix

Salary:

67.92 - 101.02 USD / Hour

American Nursing Care

Expiration Date

Until further notice

Requirements

Bachelors Of Science - Information Technology, Health Informatics, or related field required
Masters Of Science - Information Technology, Health Informatics, or related field preferred
10+ years in healthcare IT, with 5+ years in a leadership role
Experience with managed care models (Medicare Advantage, ACO, Medicaid), HIE integration, and population health tools (e.g., Epic EZCap, QNext, Healthy Planet, Innovaccer,)
Experience with FHIR, HL7, CCD, APIs, and other interoperability standards
Familiarity with ACO, CIN, and value-based care models

Job Responsibility

Lead the design and implementation of IT systems that support managed care and population health objectives
Align systems architecture with organizational strategies related to value-based care, ACOs, Medicare Advantage, Medicaid, and commercial payer programs
Oversee integration of clinical and claims data to support whole-person care
Ensure systems support care coordination workflows, care management documentation, and chronic condition tracking
Manage platforms that support risk stratification, predictive modeling, and attribution logic
Collaborate with clinical leadership to build technology-enabled pathways for preventive care, care gaps, and patient engagement
Lead and mentor the End User Services team, ensuring excellent IT support for clinicians, case managers, analysts, and administrative staff
Develop and monitor SLAs, support KPIs, incident response times, and user satisfaction metrics
Oversee help desk operations, ticketing systems, desktop support, hardware/software provisioning, and user access governance
Direct the architecture and scalability of population health IT platforms and managed care applications

What we offer

medical
prescription drug
dental
vision plans
life insurance
paid time off (full-time benefit eligible team members may receive a minimum of 14 paid time off days, including holidays annually)
tuition reimbursement
retirement plan benefit(s) including, but not limited to, 401(k), 403(b), and other defined benefits offerings

Fulltime

New

Accounts Receivable Administrator in Claims

This role will be responsible for maintaining the unsubmitted ledger for both cu...

Location

Ireland

Salary:

Not provided

Blackrock Health Hermitage Clinic

Expiration Date

Until further notice

Requirements

Numerical and analytical skills
Interest in change management and process improvement
Proficient in Microsoft Excel
Excellent communication skills both verbal & written
Flexible
Valid work permission for the Republic of Ireland (or eligible for a work permit in the case of critical skills)

Job Responsibility

Review Patient claim packs for accuracy and completeness and obtain any missing information required to submit the claim for assessment to the relevant Insurer
Identification of claims with errors that cannot be submitted to the Insurers and being pro-active in trying to resolve them in a timely manner
Daily scanning and submissions of claims to relevant third party in accordance with their relevant cut-off dates whilst ensuring swift turnarounds along with a high standard of quality
Assisting in the management of consultant files ensuring paperwork is chased and received in a timely manner, requesting and copying charts where necessary
Resolution and resubmission of any VHI returns that come back as quality errors
Acquire a full understand of the Insurer contracts and the rules of billing and submissions
Weekly reconciliation of claims submitted to each Insurer between diary entry, OA and the claim summary sheet
Assisting with filing, cash collection and other ad-hoc duties required
Deal with routine calls from patients, consultants and staff, resolving daily or escalating to your Team Lead if further action is required but taking responsibility for ensuring the notes in OA are kept up to date and assisting where possible to close out the query
Supporting the standardisation and improvement of processes, procedures, controls, and systems

What we offer

Competitive salary
Pension
Discounted café
Sports and Social club
Employee Assistance Programme
Discounted onsite pharmacy

Fulltime

New

Medical Collections Specialist

We are in search of a diligent Medical Collections Specialist to join our team i...

Location

United States , Sacramento

Salary:

Not provided

Robert Half

Expiration Date

Until further notice

Requirements

Proficiency in Medical Collections is a must
Familiarity with Medical Terminology is required
Demonstrable knowledge of Medical Terminology is essential
Experience in handling Claim Denials is necessary
Understanding of the HealthCare Revenue Cycle is crucial
Knowledge of HealthCare Reimbursement is a significant requirement

Job Responsibility

Ensure accurate and efficient processing of medical collections
Uphold comprehensive records relating to patient accounts and collections
Proficiently read and understand medical contracts to determine the permitted amount
Display a strong comprehension of insurance products such as HMO, PPO, and Medicare Advantage plans
Exhibit strong skills in writing appeals and effectively work with insurance companies to resolve denied or underpaid claims
Comfortably communicate with patients regarding their balances and explain adjudication outcomes
Apply analytical skills to make sound decisions on claim resolutions
Exhibit efficiency in managing a fast-paced, high volume work environment, while maintaining quality and meeting production goals
Foster a team-oriented environment and excel in achieving set objectives

What we offer

medical, vision, dental, and life and disability insurance
eligible to enroll in our company 401(k) plan

Medicaid Billing Specialist

Pafford Medical Services is seeking a detail-oriented and experienced Medicaid B...

Location

United States

Salary:

Not provided

Pafford EMS

Expiration Date

Until further notice

Requirements

Minimum of 2-3 years of experience in medical billing, with a focus on Medicaid billing and follow-up
In-depth knowledge of Medicaid regulations, coding (ICD-10, CPT), and billing procedures
Experience with medical billing software and electronic health records (EHR) systems
Strong analytical and problem-solving abilities
Excellent attention to detail and accuracy
Effective communication and interpersonal skills
Ability to work independently and manage multiple tasks
Proficiency in Microsoft Office Suite (Word, Excel)
High School Diploma or GED
Minimum of 2-3 years revenue cycle management experience

Job Responsibility

Accurately prepare and submit Medicaid claims for services rendered by Pafford EMS
Ensure all claims are coded correctly and comply with Medicaid regulations and guidelines
Monitor and verify patient eligibility and insurance coverage
Conduct follow-up on outstanding claims and ensure timely resolution of billing issues
Communicate with Medicaid offices, patients, and other relevant parties to resolve claim discrepancies, denials, or rejections
Review and appeal denied claims, providing necessary documentation and information
Maintain accurate and up-to-date records of billing activities, payments, and follow-ups
Generate regular reports on billing status, outstanding claims, and payment trends
Stay informed about changes in Medicaid regulations and billing procedures
Participate in training and development opportunities to enhance knowledge and skills

Fulltime

Senior Data Scientist - Value & Access

As the Data Scientist at Amgen, you will be responsible for developing and deplo...

Location

India , Hyderabad

Salary:

Not provided

Amgen

Expiration Date

Until further notice

Requirements

Master’s degree in computer science, statistics or STEM majors with a minimum of 5 years of Information Systems experience
Bachelor’s degree in computer science, statistics or STEM majors with a minimum of 7 years of Information Systems experience
Foundational understanding of US pharmaceutical ecosystem and Patient support services offerings (Copay) and other standard data sets including claims, prescription
Experience with one or more analytic software tools or languages like R and Python
Strong foundation in machine learning algorithms and techniques
Experience in statistical techniques and hypothesis testing, experience with regression analysis, clustering and classification

Job Responsibility

Drive full lifecycle of Data Science projects delivery and ability to guide data scientists in shaping the developing the solution and act as a subject matter expert in solving development and commercial questions
Assume the role of business owner and manage the Proprietary AI engine built to optimize Copay
Support Amgen Gross to Net and other V&A Transformation initiatives
Ensure models are trained with the latest data and meet the SLA expectations
Manage AI tool’s road map, working with a global cross functional team
Work in technical teams in development, deployment, and application of applied analytics, predictive analytics, and prescriptive analytics
Utilize technical skills such as hypothesis testing, machine learning and retrieval processes to apply statistical and data mining techniques to identify trends, create figures, and analyze other relevant information
Perform exploratory and targeted data analyses using descriptive statistics and other methods
Model/analytics experiment and development pipeline leveraging MLOps
Oversee efforts of 1-3 associates, including setting performance standards, managing their staffing, and monitoring performance

Patient Claims Analytics Manager

Amgen

Location:
India , Hyderabad

Category:
IT - Software Development

Contract Type:
Not provided

Salary:

Job Description:

Job Responsibility:

Requirements:

Nice to have:

Additional Information:

Job Posted:
January 12, 2026

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