• Director, Reimbursement Configuration

    Healthfirst (NY)
    … methodologies and regulatory frameworks governing health plan reimbursement methods in Medicare , Medicaid and commercial insurance markets + Experience leading ... & Responsibilities:** + Drive flexible, repeatable and scalable claims configuration design and implementation processes with industry best-practices + Engage… more
    Healthfirst (09/28/24)
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  • Payment Integrity Analyst III (ALD)

    LA Care Health Plan (Los Angeles, CA)
    …or in Payment Integrity. At least 5 years participating in healthcare ( Medicare , Medicaid , Commercial). At least 5 years of experience with health care ... Payment Integrity Analyst III (ALD) Job Category: Claims...implementation. Skills Required: Knowledge in CPT, HCPCS, ICD-9, ICD-10, Medicare , and Medicaid rules and regulations. Working… more
    LA Care Health Plan (11/06/24)
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  • VP, Payment Integrity - REMOTE

    Molina Healthcare (Louisville, KY)
    …preferably leading content development * 5+ years Managed Care payor experience, preferably Medicare / Medicaid experience * 5+ years of leadership experience at ... **Job Description** **Job Summary** The VP, Payment Integrity position provides strategic leadership, vision, and expertise in support of the cross-functional … more
    Molina Healthcare (10/17/24)
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  • AVP, Clinical Validation ( Payment

    Molina Healthcare (NE)
    …relevant Clinical Review Programs * 5+ years Managed Care payor experience, preferably Medicare / Medicaid experience * Rich understanding of ICD-9/10CM, MS-, ... **Job Description** **Job Summary** The AVP, Clinical Validation (PI) role within Payment Integrity utilizes clinical background and relevant experience to lead the… more
    Molina Healthcare (11/07/24)
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  • Senior Payment Integrity Analyst

    HealthEdge Software Inc (Columbus, OH)
    …and enterprise level. Our Reimbursement Transformation features Medicare and Medicaid content coupled with flexible contract configuration capabilities for ... **Overview** **Position Overview:** We are seeking a Senior Payment Integrity Specialist to play a key role in building and implementing proprietary healthcare edits… more
    HealthEdge Software Inc (11/06/24)
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  • Healthcare Medical Claims Coding Sr. Analyst

    Commonwealth Care Alliance (Boston, MA)
    …as necessary on all new and revised coding logic, related Medicare / Medicaid policies for review/approval through the Payment Integrity governance process. ... public health care programs and reimbursement methodologies ( Medicaid and Medicare ) + Medical Coding, Compliance, Payment Integrity and Analytics +… more
    Commonwealth Care Alliance (10/17/24)
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  • Contract Integrity Specialist

    Intermountain Health (Murray, UT)
    …contracts related to payment integrity and monitoring, reviewing and interpreting Medicare and Medicaid policies, payment methodologies, and updates to ... data related to the payment of contracts, fee schedules and Medicare and Medicaid regulations and methodologies. Conducts internal and external contract… more
    Intermountain Health (11/08/24)
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  • Enrollment & Billing Operations - Hybrid

    Fallon Health (Worcester, MA)
    …strive to be the leading provider of government-sponsored health insurance programs-including Medicare , Medicaid , and PACE (Program of All-Inclusive Care for the ... all regulatory products. Responsible to reconcile the accuracy of payment file received from online premium payment ...P&P's + Serve as resource to other areas for Medicare and Medicaid questions/issues + Assists Management… more
    Fallon Health (10/13/24)
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  • AVP, Arizona Health Plan Operations (Must reside…

    Molina Healthcare (Phoenix, AZ)
    …* This position plans, organizes, staffs, and coordinates the operations of state Medicaid /CHIP, Medicare and Marketplace Health Plan operations. * Works with ... the functionality of Health Plan Operations. * Directly manages the Plan's benefit configuration , claim payment policies and the maintenance or modification of… more
    Molina Healthcare (11/02/24)
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  • Principal Systems Engineer

    Humana (Columbus, OH)
    …efforts are leading to a better quality of life for people with Medicare , Medicaid , families, individuals, military service personnel, and communities at large. ... health first** The Principal Systems Engineer is responsible for design, analysis, configuration and maintenance of complex systems software solutions, based on a… more
    Humana (10/29/24)
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  • Senior Software Engineer-Splunk

    Humana (Columbus, OH)
    …efforts are leading to a better quality of life for people with Medicare , Medicaid , families, individuals, military service personnel, and communities at large. ... and hands-on within Splunk AWS; editing and maintaining Splunk configuration files and apps. As a Senior software engineer,...Montana, or South Dakota will be provided a bi-weekly payment for their internet expense. Humana will provide Home… more
    Humana (11/01/24)
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  • Customer Success Manager

    HealthEdge Software Inc (Columbus, OH)
    …and enterprise level. Our Reimbursement Transformation features Medicare and Medicaid content coupled with flexible contract configuration capabilities for ... Product:** _With Source_ ,we'rechanging the industry narrative,providinga moreholistic approachto payment integrity that focuses on comprehensive reimbursement, agile editing,...the reimbursement, payment integrity,… more
    HealthEdge Software Inc (10/10/24)
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  • Senior Cloud Security Engineer(remote)

    Humana (Columbus, OH)
    …efforts are leading to a better quality of life for people with Medicare , Medicaid , families, individuals, military service personnel, and communities at large. ... Defense & Response Team** during security incidents, involving timely configuration changes to Prisma and frequent participation on major...home in the state of California will be provided payment for their internet expense. + A minimum standard… more
    Humana (11/06/24)
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  • Senior Network Engineer

    Humana (Frankfort, KY)
    …efforts are leading to a better quality of life for people with Medicare , Medicaid , families, individuals, military service personnel, and communities at large. ... escalation in response to incidents/requests regarding network performance and configuration , including off hours escalations + Maintain network documentation,… more
    Humana (10/30/24)
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  • Supervisor Priority Health Provider Reimbursement

    Corewell Health (Grand Rapids, MI)
    Job Summary Supervises the provider contract reimbursement set up and ensures the configuration aligns with the provider payment and billing policies. Manages ... 3 years of relevant experience working with provider reimbursement methods in Medicare / Medicaid /Commercial spaces + 7 years of relevant experience using… more
    Corewell Health (10/26/24)
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  • Behavioral Health Account Manager

    Healthfirst (NY)
    …+ Experience and understanding of health care reimbursement methodologies + Knowledge of Medicare and Medicaid products + Must have either: Behavioral Health, ... Patient Agreement for Out of Network providers in order to determine the providers payment arrangement. Individual must be familiar with or have the ability to learn… more
    Healthfirst (10/24/24)
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  • Senior Citrix Systems Engineer…

    Humana (Columbus, OH)
    …efforts are leading to a better quality of life for people with Medicare , Medicaid , families, individuals, military service personnel, and communities at large. ... GSLB, and implement load balancing best practices + Familiarity with configuration , installation, and maintenance of Citrix Provisioning Services and Citrix… more
    Humana (11/06/24)
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  • Associate Director Cloud Architecture

    Humana (Columbus, OH)
    …efforts are leading to a better quality of life for people with Medicare , Medicaid , families, individuals, military service personnel, and communities at large. ... innovation. + **Automation** : Implement automation processes for provisioning, configuration management, and deployment of data platform services. + **Budget… more
    Humana (11/02/24)
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  • Director, Provider Management Solution Lead

    Healthfirst (FL)
    …and influencing impact and progress to senior leadership + Experience with Medicare / Medicaid and Commercial Healthcare + Strong leadership capability with ... in Provider Data Management, Provider Contract, and/or Provider Reimbursement Configuration + Strong program management experience + Experience with system… more
    Healthfirst (10/23/24)
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  • VP, Network Management & Operations (Florida)

    Molina Healthcare (Mid Florida, FL)
    …area to ensure accuracy of provider information in support of accurate configuration for claims payment . **JOB QUALIFICATIONS** **Required Education** Bachelor's ... in Business, Health Administration, or related field. **Preferred Experience** Experience with Medicaid and Medicare managed care plans. To all current Molina… more
    Molina Healthcare (10/16/24)
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