- Sun Pharmaceuticals, Inc (Washington, DC)
- …developed analytical skills with demonstrated ability to conceptualize issues and synthesize data to provide strategic direction Experience in Sun Pharmas ... Field Reimbursement Manager Overview: The Field Reimbursement Manager ...(coverage, coding & payment), specialty pharmacy and distribution processes, provider support services (eg, benefits investigation) and patient support… more
- CVS Health (Annapolis, MD)
- …all with heart, each and every day. **Position Summary** + Lead a team of Medicaid Provider Data Services Analysts responsible for loading and maintaining ... Medicaid Provider data within Aetna QNXT. + Team...Medicaid Provider data within Aetna QNXT. + Team...or Network operations. + 1+ years of experience in Medicaid provider operations. + At least 1… more
- Humana (Annapolis, MD)
- …Pricer Business and System Support team responsible for administering complex Medicaid provider reimbursement methodologies. The associate will support existing ... be primarily responsible for implementation, maintenance and support of Medicaid provider reimbursement for hospitals and facilities....EAPG + 2+ years of experience with Optum Rate Manager + 2+ years of experience with Optum WebStrat… more
- CVS Health (Annapolis, MD)
- … Manager of Claims Management is responsible for overseeing Medicaid claims operations, inventory management, quality assurance, and compliance monitoring. This ... federal regulations, contractual requirements, and organizational performance standards. The manager partners cross-functionally with Provider Relations, Configuration,… more
- Humana (Annapolis, MD)
- …providers, with full accountability from strategy to execution. The Lead Product & Strategy Manager - Provider Practice Management role is a critical member of ... first** We are looking for a dynamic Lead Product Manager to develop clinical solutions for our members and...-friendly insights. + Lead the design and refinement of provider -facing data views (dashboards, insights, performance summaries)… more
- AmeriHealth Caritas (Washington, DC)
- …Responsible for assisting the Leader with departmental activities related to provider satisfaction, education, and communication. This position is also responsible ... for all provider network recruiting and contracting management activities as it...with claim payment methodologies. + Maintains familiarity with State Medicaid fee schedules and analyzes comparable Plan pricing guidelines.… more
- NTT America, Inc. (Baltimore, MD)
- **Req ID:** 343399 NTT DATA strives to hire exceptional, innovative and passionate individuals who want to grow with us. If you want to be part of an inclusive, ... adaptable, and forward-thinking organization, apply now. We are currently seeking a APD Manager to join our team in Baltimore, Maryland (US-MD), United States (US).… more
- CenterWell (Annapolis, MD)
- …part of our caring community and help us put health first** The Manager of Pre-Bill Audit provides strategic leadership and operational oversight for the ... improvements in unbilled rates, revenue cycle performance, and compliance. The Manager leads a team of Pre-Bill Specialists, partners with senior leadership,… more
- Humana (Annapolis, MD)
- …telephony, data systems, and enterprise architecture. The Senior Product Manager will serve as a key interface between business and technology, driving ... and help us put health first** The Senior Product Manager Conceives of, develops, delivers, and manages products for...to complex issues where the analysis of situations or data requires an in-depth evaluation of variable factors. Senior… more
- Humana (Annapolis, MD)
- …technical program management, including at least 3 years as a Technical Product Manager in data , AI/ML, or personalization platforms. + Demonstrated success in ... advanced agentic AI decision-making across our organization. As a Lead Technical Product Manager (PM-T), you will be responsible for shaping the vision, defining the… more
- Cardinal Health (Annapolis, MD)
- …conducts investigations to resolve ethics and compliance issues. **Compliance Audit Manager ** Reporting to the Compliance Director, this position supervises and ... annual enterprise risk assessment and audit and monitoring plan. The Manager has supervisory responsibility for all Compliance Audit staff. **Responsibilities** +… more
- Humana (Annapolis, MD)
- …us put health first Humana's Product organization is seeking a Lead Product Manager to drive the strategy, development, and optimization of the Adobe Experience ... translating business needs into platform capabilities that enable personalized, data -driven customer experiences. You'll work closely with cross-functional teams to… more
- Humana (Annapolis, MD)
- …healthcare through AI excellence. We are seeking a dynamic and experienced Lead Product Manager to join our team (known internally as Lead, IT Product Management) to ... our customers. Join our rapidly expanding team of dedicated product managers, data scientists, engineers, policy experts, and business leaders as we work together… more
- Cardinal Health (Annapolis, MD)
- ** Manager , Revenue Cycle Manager , Collections** **About Navista** We believe in the power of community oncology to support patients through their cancer ... with a strong emphasis on oncology practice needs. **_Job Purpose:_** The Manager , Revenue Cycle Management, is responsible for overseeing the insurance collection… more
- Philips (Washington, DC)
- **Territory Manager - RespirTech (Baltimore, ME, Annapolis, ME, Wilmington, ME)** RespirTech's Territory Manager represents the InCourage airway clearance ... evidence to physicians. + Being an expert on Medicare, Medicaid and private insurance coverage-criteria for InCourage vest therapy,...in order for coverage to be obtained. + Analyzing data to effectively target priority healthcare teams and create… more
- CVS Health (Annapolis, MD)
- …data analyses to support investigations of potential fraud, waste, and abuse in Medicaid claims and provider activity. + Prepare timely and accurate ... and data integrity. + Stay informed about changes in Medicaid policy, regulatory requirements, and FWA detection techniques to ensure ongoing compliance.… more
- Elevance Health (Woodlawn, MD)
- …supervisory review of work completed by other associates. + Analyze and interpret data per a provider 's trial balance, financial statements, financial documents, ... Medicare and partner with the Centers for Medicare and Medicaid Services to transform federal health programs. The **Audit...you will make an impact:** + Analyzes and interprets data and makes recommendations for change based on judgment… more
- CenterWell (Annapolis, MD)
- …Internal Medicine, or Geriatric Medicine . Active and unrestricted DEA license . Medicare Provider Number . Medicaid Provider Number . Excellent verbal and ... Primary Care, Humana's Primary Care Organization. This group will provide virtual wraparound services to support patients when they...to act as a resource for the advanced practice provider to ensure exceptional patient care. . Follow policy… more
- Public Consulting Group (Annapolis, MD)
- …administrative tasks and the entire claim process. The independent contractor will provide contract support through data entry, report extract and analysis, ... needed. Ensures accurate system support through review and updating reference data , contractual metrics, and compliance metrics. Ensures accurate RMC support through… more
- Elevance Health (Hanover, MD)
- …employment, unless an accommodation is granted as required by law._ **Summary** Provide support for CarelonRx including trend and rebate analytics and delivering a ... **Position Responsibilities** + Complete pharmacy trend and rebate analytics for Medicaid , Medicare and/or Commercial and improve reporting and linkage to… more
