- 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. ... us put health first** The Senior Data Manager supports all aspects of configuration control, data management, and deficiency reporting. The Senior Data Manager work… more
- CDPHP (Albany, NY)
- …rules, regulations, enrollment/eligibility guideline and reporting requirements for HMO, PPO, ASO, Medicare , Medicaid , Family Health Plus and Child Health Plus ... to be a part of that experience. The Manager, Configuration will have the responsibility for the oversight, development...compensation, CDPHP employees may be eligible for an incentive payment , a discretionary cash reward based on employee and… more
- 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
- 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
- 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
- CenterLight Health System (NY)
- … integrity, including root cause analysis, reconciliation to provider contracts/agreements and Medicare fee schedule. + Develop analytics of payment trends that ... JOB PURPOSE: The Senior Project Manager, Claims Payment Integrity supports the Senior Vice President and...Experience with project management. + Industry level knowledge of Medicaid and Medicare rules, regulations, and processes.… more
- 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
- 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
- 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
- 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
- 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 (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
- HealthEdge Software Inc (Columbus, OH)
- …and enterprise level. Our Reimbursement Transformation features Medicare and Medicaid content coupled with flexible contract configuration capabilities for ... Source_ ,we'rechanging the industry narrative, providing a moreholistic approachto payment integrity that focuses on comprehensive reimbursement, agile editing,...the reimbursement, payment integrity,… more
- 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
- 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
- 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
- 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. ... + Optimizes database access and allocates/re-allocates database resources for optimum configuration , database performance and cost. + Supports multiple services and… more
- 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. ... + 5+ years of Systems Engineering ITIL experience, in design, analysis, configuration , and maintenance of complex systems software solutions and infrastructure. +… more
- 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. ... IaaC ; Terraform & ARM templates + Experience with configuration tools like Ansible or Puppet + Well versed...Montana, or South Dakota will be provided a bi-weekly payment for their internet expense. + Humana will provide… more
- 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