- CVS Health (Oklahoma City, OK)
- …you all the way! This is a fulltime teleworker opportunity in Oklahoma. The Senior Claim Data Specialist handles end-to-end processes associated with claim data ... Fundamental Components: Reviews pre-specified claims or claims that exceed specialist adjudication authority or processing expertise. Applies medical necessity… more
- WellSpan Health (Lancaster, PA)
- …80 hrs/2 weeks Day shift Pathways to Hope: A First Episode Psychosis Program through WellSpan Philhaven Be part of launching Pathways to Hope, an innovative ... program in Lancaster County supporting individuals experiencing a first...a first episode of psychosis. As a Certified Peer Specialist (CPS), you'll use your lived experience to support… more
- Novo Nordisk Inc. (Buffalo, NY)
- …Cardiometabolic Care Specialist I - $86,000 to $106,000 Cardiometabolic Care Specialist II - $113,000 to $138,000 Senior Cardiometabolic Care Specialist ... level impact Demonstrates understanding of the local payer market including Medicare , Commercial and Medicaid benefit designs, Payer Coverage, Prescription Coverage… more
- UPMC (Pittsburgh, PA)
- UPMC's Health Plan and WorkPartners are hiring an EAP Specialist for their LifeSolutions Clinical Services Team. This is a hybrid role that will work partially ... the direction of LS Clinical Director and/or the Medical Director, the EAP Specialist is responsible for providing the clinical services for the Employee Assistance … more
- Cleveland Clinic (Cleveland, OH)
- …healthcare organizations in the world. The Safety and Quality Patient Experience Specialist II (SQPE) leads safety, quality, and experience work at our Cleveland ... Clinic Main Campus. The Specialist coordinates and implements improvement initiatives. The focus of...organization. Build relationships with project teams, middle management, and senior sponsors. Coach smaller improvement teams to success with… more
- University of Southern California (Alhambra, CA)
- …between the CDM residing in the billing system and CDM management tools . The Senior RI Specialist shall ensure that the Chargemaster (CDM) is consistent with ... provided. This includes ensuring all annual updates required by Medicare and other third-party payers are up to date....and other third-party payers are up to date. The Senior RI Specialist delivers direction to the… more
- City and County of San Francisco (San Francisco, CA)
- …2232's may include, but are not limited to: + Disease Prevention and Control Senior Specialist /Medical Director + Provides clinical oversight of a unit or clinic ... COVID, influenza, measles, Salmonella, HIV, STIs, Tuberculosis or emerging diseases. + Senior Specialist in Forensic Pathology + Performs medicolegal autopsies… more
- Access: Supports For Living (Middletown, NY)
- Senior Billing Specialist Location: Middletown, NY, United StatesDate Posted: Dec 12, 2025 Share: share to e-mail Apply Now Save JobSaved Description Location: ... (40hrs) Job Description: Reporting to the A/R Manager, the Senior Billing Specialist is a key position...of weekly claims processing + Analyze, billing and processing program claims for accuracy and completeness; submit claims to… more
- Minnesota Visiting Nurse Agency (Minneapolis, MN)
- *_SUMMARY_* We are currently seeking a*Registration Specialist Senior * to join our**Admitting and Registration. **This 0.50 (40 hours per pay period) role will ... Other Weekend, 11:30 PM - 8:00 AM). *Purpose of this position:*Registration Specialist Senior provides revenue cycle services and assumes responsibility for… more
- Molina Healthcare (NE)
- …and/or collaboratively with other departments. **Job Duties** + Acts as a lead specialist to provide project, program , and/or initiative related direction and ... **Job Description** **Job Summary** The Sr Specialist , Member & Community Interventions oversees and implements new and existing clinical quality member intervention… more
- Blue Cross Blue Shield of Massachusetts (Boston, MA)
- … works closely with CPR's Director and Clinical Lead, Operations Lead, Senior Credentialing Manager/ Compliance Consultant, Risk Specialist , Exception Review ... your true colors to blue. The Role:The Peer Review Specialist is responsible for monitoring the quality of the...+ Medical Directors + Member Appeals Grievance Programs (Commercial, Medicare Advantage, and InterPlan Program ) + Physician… more
- Marshfield Clinic (Marshfield, WI)
- …most exciting missions in the world!** **Job Title:** Pharmacy Systems Support Specialist Senior **Cost Center:** 301641560 System Ancillary Region-340b Admin ... America) **Job Description:** **JOB SUMMARY** The Pharmacy Systems Support Specialist Senior helps facilitate and support the...or be excluded from participation in any federally funded program , including Medicare and Medicaid. This is… more
- CVS Health (Oklahoma City, OK)
- …all the way! This is a fulltime teleworker opportunity in Oklahoma. The ** Senior Claim Data Specialist ** handles end-to-end processes associated with claim data ... Components:** + Reviews pre-specified claims or claims that exceed specialist adjudication authority or processing expertise. + Applies medical necessity… more
- Molina Healthcare (Rockford, IL)
- …accreditation surveys and federal/state QI compliance activities. **KNOWLEDGE/SKILLS/ABILITIES** The Senior Specialist , Quality Interventions / QI Compliance ... and Quality Improvement Compliance. + Acts as a lead specialist to provide project-, program -, and /...Healthcare. **Preferred Experience** + 1 year of experience in Medicare and in Medicaid. + Experience with data reporting,… more
- CenterWell (Booneville, MS)
- …a part of our caring community and help us put health first** As a ** Senior Clinical Home Health Specialist ** , you will call on physicians, hospital, skilled ... in special projects, quarterly Customer Appreciation Week events and specialty program launches. **Use your skills to make an impact** **Required Experience/Skills:… more
- WellSpan Health (Lancaster, PA)
- …**No holidays** **On call rotation** **Pathways to Hope: A First Episode Psychosis Program through WellSpan Philhaven** **_Be part of launching Pathways to Hope, an ... innovative program in Lancaster County supporting individuals experiencing a first...a first episode of psychosis._** **_As a Certified Peer Specialist (CPS), you'll use your lived experience to support… more
- Spurwink Services (Portland, ME)
- …| Full Time Finance-Patient Accounts department seeks a seasoned accounts receivable specialist , this position contributes to the mission of Spurwink by working ... HIPAA) is required. Knowledge, Skills and Abilities Necessary: Proficient in Medicare , Maine Care, Commercial and WC billing, reimbursement and collections. Ability… more
- Molina Healthcare (Green Bay, WI)
- …individual subscriber or responsible party with the amount due for the healthcare program the member is enrolled. * Guide and support Member Service representatives ... timely and accurate processing of payment received.* Marketplace, Commercial, or Medicare healthcare experience with premium billing and reconciliation. * Must have… more
- Centers for Medicare & Medicaid Services (Woodlawn, MD)
- …monitoring casework from individuals and their advocates entitled to aspects of the Medicare Program . AND (4) Leading strategic planning activities focused on ... Inquiries, Medicare Ombudsman Group. As a Supervisory Health Insurance Specialist , GS-0107-15, you will provide strategic management and leadership direction to… more
- New York State Civil Service (Thiells, NY)
- … program of care. Medical Specialists 2 serve as senior practicing specialists, within a recognized discipline of medicine.Other responsibilities include:* ... Yes Agency People With Developmental Disabilities, Office for Title Medical Specialist 2 Occupational Category Health Care, Human/Social Services Salary Grade 38… more
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