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

Clinical Risk Management Analyst

Location

United States , Aurora

Salary:

38.20 - 57.30 USD / Hour

Advocate Health Care

Expiration Date

Until further notice

Requirements

If RN, Active, unrestricted registered nurse (RN) multi-state compact and/or single-state license with privileges to practice in the state(s) where the RN is providing client nursing services
Graduate of a Board of Nursing approved nursing education program
Typically requires 5 years of experience in healthcare, quality and/or risk management, which includes experience in risk management principles, and continuous quality improvement tools and concepts
Knowledge of federal, state and other external health care regulations and standards and ability to research those regulations
Knowledge of evidence based, best practice resources to promote efficiency and effective outcomes
Working knowledge of process improvement methods and statistical tools
Effective conflict management and resolution skills
Basic working knowledge of medical terminology, clinical concepts and disease management
Intermediate computer skills including experience in using Microsoft Office (Excel, Word, Power Point, Access) or similar products
Strong written and oral communication skills including good presentation skills

Job Responsibility

Collaborates with claims adjustors and defense counsel in managing claims including assessment of liability, ensuring establishment of appropriate reserves, maintaining complete and up-to-date case files, and assisting in procurement of medical records and documents necessary for evaluation and defense of cases
Facilitates timely response and investigation of adverse and significant events
Collects and evaluates data concerning incident reports, aggregates data summaries, and develops monthly and quarterly risk management reports that provide a summary of current claims and litigation, to include an analysis of trends
Shares reports with appropriate leadership and advises and recommends actions for process improvement
Maintains an accurate, up-to-date database reflecting the status and essential elements of current claims and litigation
Analyzes patient concerns or complaints to determine the root of the matter, identifies any trends, and determines how best to address the concern or complaint
Reviews and gathers pertinent information from patient records
Collaborates with other risk staff in the prompt, equitable resolution of claims
Provides consultative and resource support to staff regarding all aspects of risk management
Coordinates, facilitates, implements and participates in care management and quality improvement initiatives

What we offer

Paid Time Off programs
Health and welfare benefits such as medical, dental, vision, life, and Short- and Long-Term Disability
Flexible Spending Accounts for eligible health care and dependent care expenses
Family benefits such as adoption assistance and paid parental leave
Defined contribution retirement plans with employer match and other financial wellness programs
Educational Assistance Program

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

Patient Access Liaison

Join Amgen’s Mission of Serving Patients. At Amgen, if you feel like you’re part...

Location

United States , Houston

Salary:

178336.00 - 201298.00 USD / Year

Amgen

Expiration Date

Until further notice

Requirements

Doctorate degree AND 2 years of Sales/ Account Management OR direct patient care experience
Master's degree AND 4 years of Sales/ Account Management OR direct patient care experience
Bachelor's degree AND 6 years of Sales/Account Management OR direct patient care experience
Scientific background and ability to learn product and disease information
Nursing or other clinical background a plus
Access and reimbursement for buy and bill products
Orphan or Rare disease experience
Familiarity with HIPAA guidelines and FDA requirements
Familiarity with and Adherence to internal and OIG Compliance guidelines a must
Ability to handle difficult patient cases and resolve hurdles

Job Responsibility

Secure written or electronic patient HIPAA for patients in the assigned geography
Develop relationships with patients and caregivers by engaging via phone, text, email, virtual or in person connections
Assess individual needs of the patient and develop an appropriate education and resource plan of action, considering the patient’s family and team of healthcare providers to empower the patient to become their own advocate
Educate the patient on Krystexxa coverage based on their benefits and the steps needed to gain prior authorization to ensure understanding of the process for medication access
Provide information on co-pay assistance programs, national foundations, and free drug programs by sharing information to patients as appropriate and needed
Provide proactive education to prescribers and sites of care upon patient enrollment on coverage for Amgen rare disease therapies, common prior authorization requirements, and coding and billings requirements
Provide access and reimbursement education based on the enrolled patient’s Krystexxa benefits to physician offices and sites of care
Educate the physician office and/or SOC on Krystexxa coverage based on the patient’s benefits and the steps needed to gain prior authorization to ensure understanding of the process for medication access
Investigate access challenges pre and post-infusion to include support for denied claims and claim reviews
Partner with Safety and PV and report AE’s and product complaints through medical information

What we offer

A comprehensive employee benefits package, including a Retirement and Savings Plan with generous company contributions, group medical, dental and vision coverage, life and disability insurance, and flexible spending accounts
A discretionary annual bonus program, or for field sales representatives, a sales-based incentive plan
Stock-based long-term incentives
Award-winning time-off plans
Flexible work models where possible

Fulltime

Patient Access Liaison

In this vital role you will provide logistical, non-medical educational assistan...

Location

United States , Pittsburgh

Salary:

178336.00 - 201298.00 USD / Year

Amgen

Expiration Date

Until further notice

Requirements

Doctorate degree AND 2 years of Sales/ Account Management OR direct patient care experience
Master's degree AND 4 years of Sales/ Account Management OR direct patient care experience
Bachelor's degree AND 6 years of Sales/Account Management OR direct patient care experience
Scientific background and ability to learn product and disease information
Nursing or other clinical background a plus
Access and reimbursement for buy and bill products
Orphan or Rare disease experience
Familiarity with HIPAA guidelines and FDA requirements
Familiarity with and Adherence to internal and OIG Compliance guidelines a must
Ability to handle difficult patient cases and resolve hurdles

Job Responsibility

Secure written or electronic patient HIPAA for patients in the assigned geography
Develop relationships with patients and caregivers by engaging via phone, text, email, virtual or in person connections
Assess individual needs of the patient and develop an appropriate education and resource plan of action, considering the patient’s family and team of healthcare providers to empower the patient to become their own advocate
Educate the patient on Krystexxa coverage based on their benefits and the steps needed to gain prior authorization to ensure understanding of the process for medication access
Provide information on co-pay assistance programs, national foundations, and free drug programs by sharing information to patients as appropriate and needed
Provide proactive education to prescribers and sites of care upon patient enrollment on coverage for Amgen rare disease therapies, common prior authorization requirements, and coding and billings requirements
Provide access and reimbursement education based on the enrolled patient’s Krystexxa benefits to physician offices and sites of care
Educate the physician office and/or SOC on Krystexxa coverage based on the patient’s benefits and the steps needed to gain prior authorization to ensure understanding of the process for medication access
Investigate access challenges pre and post-infusion to include support for denied claims and claim reviews
Partner with Safety and PV and report AE’s and product complaints through medical information

What we offer

A comprehensive employee benefits package, including a Retirement and Savings Plan with generous company contributions, group medical, dental and vision coverage, life and disability insurance, and flexible spending accounts
A discretionary annual bonus program, or for field sales representatives, a sales-based incentive plan
Stock-based long-term incentives
Award-winning time-off plans
Flexible work models where possible

Fulltime

Patient Access Liaison

Join Amgen’s Mission of Serving Patients. At Amgen, if you feel like you’re part...

Location

United States , Kansas City; St. Louis

Salary:

178336.00 - 201298.00 USD / Year

Amgen

Expiration Date

Until further notice

Requirements

Doctorate degree AND 2 years of Sales/ Account Management OR direct patient care experience
Master's degree AND 4 years of Sales/ Account Management OR direct patient care experience
Bachelor's degree AND 6 years of Sales/Account Management OR direct patient care experience
Scientific background and ability to learn product and disease information
Nursing or other clinical background a plus
Access and reimbursement for buy and bill products
Orphan or Rare disease experience
Familiarity with HIPAA guidelines and FDA requirements
Familiarity with and Adherence to internal and OIG Compliance guidelines a must
Ability to handle difficult patient cases and resolve hurdles

Job Responsibility

Secure written or electronic patient HIPAA for patients in the assigned geography
Develop relationships with patients and caregivers by engaging via phone, text, email, virtual or in person connections
Assess individual needs of the patient and develop an appropriate education and resource plan of action, considering the patient’s family and team of healthcare providers to empower the patient to become their own advocate
Educate the patient on Krystexxa coverage based on their benefits and the steps needed to gain prior authorization to ensure understanding of the process for medication access
Provide information on co-pay assistance programs, national foundations, and free drug programs by sharing information to patients as appropriate and needed
Provide proactive education to prescribers and sites of care upon patient enrollment on coverage for Amgen rare disease therapies, common prior authorization requirements, and coding and billings requirements
Provide access and reimbursement education based on the enrolled patient’s Krystexxa benefits to physician offices and sites of care
Educate the physician office and/or SOC on Krystexxa coverage based on the patient’s benefits and the steps needed to gain prior authorization to ensure understanding of the process for medication access
Investigate access challenges pre and post-infusion to include support for denied claims and claim reviews
Partner with Safety and PV and report AE’s and product complaints through medical information

What we offer

A comprehensive employee benefits package, including a Retirement and Savings Plan with generous company contributions, group medical, dental and vision coverage, life and disability insurance, and flexible spending accounts
A discretionary annual bonus program, or for field sales representatives, a sales-based incentive plan
Stock-based long-term incentives
Award-winning time-off plans
Flexible work models where possible

Fulltime

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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