- State of Minnesota (St. Paul, MN)
- …degree for six (6) months. **Preferred Qualifications** + Experience supporting or enhancing Medicaid Management Information Systems (MMIS) or other ... you will provide advanced professional knowledge and skills in information systems problem identification, requirements definition and determination… more
- Humana (St. Paul, MN)
- …Managed Medicaid and/or Commercial products, or other Medical management organizations, hospitals/ Integrated Delivery Systems , health insurance, other ... medical management review organization, such as Medicare Advantage, managed Medicaid , or Commercial health insurance. + Experience with national guidelines such… more
- Humana (St. Paul, MN)
- …Managed Medicaid and/or Commercial products, or other medical management organizations, hospitals/ Integrated Delivery Systems , health insurance, other ... medical management review organization, such as Medicare Advantage, managed Medicaid , or Commercial health insurance. + Experience with national guidelines such… more
- Humana (St. Paul, MN)
- …impact** **Required Qualifications** + **Minimum of 2 years' professional experience in Medicaid data management , healthcare operations** + **Ability to monitor ... in encounter data submissions + Background in Medicare and/or Medicaid product management or support. + Familiarity...management or support. + Familiarity with Claims Adjudication Systems (CAS). + Knowledge of X12 transaction sets and… more
- Humana (St. Paul, MN)
- …Certification such as a Certified Public Accountant, Certified Information Systems Auditor, or Certified Internal Auditor, Project Management certification, ... is hiring a Compliance Professional who will support efforts for overall Medicaid business by joining the team overseeing the facilitation of Policy Governance.… more
- Humana (St. Paul, MN)
- …Citrix, Microsoft Azure Virtual Desktop, and others). + Oversee the lifecycle management of virtual systems , including provisioning, patching, upgrading, and ... with Humana Government Business is contingent upon your having access to government information and systems ** + 7+ years of hands-on experience in virtualization… more
- Humana (St. Paul, MN)
- …pipelines, ensuring adherence to best practices in accountable AI for effective risk management and measurement. Join us in shaping the future of healthcare through ... AI excellence. We are building advanced agentic systems capable of autonomously managing and decomposing complex goals. We are seeking an expert in agent design,… more
- CVS Health (St. Paul, MN)
- …actionable insights to support fraud, waste, and abuse (FWA) detection and Medicaid regulatory & compliance reporting. This is an individual contributor role. Job ... data analyses to support investigations of potential fraud, waste, and abuse in Medicaid claims and provider activity. + Prepare timely and accurate Medicaid … more
- Humana (St. Paul, MN)
- …Managed Medicaid and/or Commercial products, or other Medical management organizations, hospitals/ Integrated Delivery Systems , health insurance, other ... medical management review organization, such as Medicare Advantage, managed Medicaid , or Commercial health insurance. + Experience with national guidelines such… more
- Blue Cross and Blue Shield of Minnesota (Eagan, MN)
- …and analytic methods. * Helps drive the implementation of new products and systems by providing actionable information and recommendations that evaluate the ... data analysis. This roleleveragesdeepexpertiseinRiskAdjustment and healthcare data-primarily Medicare Advantage, Medicaid , and ACA Commercial-identifyingtrends and communicating insights to senior… more
- Humana (St. Paul, MN)
- …following areas: benchmarking, business process analysis and re-engineering, change management and measurement, and/or process-driven systems requirements. ... or related field + 3+ years of healthcare process improvement experience or project management , or operations ( Medicaid preferred) + 3+ years of experience in… more
- Humana (St. Paul, MN)
- …Managed Medicaid and/or Commercial products, or other Medical management organizations, hospitals/ Integrated Delivery Systems , health insurance, or ... medical management review organization, such as Medicare Advantage, Managed Medicaid , or Commercial health insurance. + Experience with national guidelines such… more
- Robert Half Accountemps (Minneapolis, MN)
- …claim research, resolution actions, and follow-up steps within billing and account management systems . + Maintain strict compliance with hospital policies, ... resubmit professional and facility claims to Medicare, Medicare Advantage (Managed Care), Medicaid , Medicaid Managed Care, and other commercial and third-party… more
- Humana (St. Paul, MN)
- …**Preferred Qualifications:** + Knowledge of the managed care industry, Integrated Delivery Systems , health insurance, or clinical group practice management + ... medical management review organization such as Medicare Advantage, managed Medicaid , or Commercial health insurance + Current and ongoing Board Certification in… more
- Humana (St. Paul, MN)
- …and Product Teams, Cloud Engineering, FinOps, Finance, Legal and Supply Management Services to ensure secure, efficient, and scalable cloud operations. This ... (GenAI) capabilities into Humana's Infrastructure Operations, blending traditional IT management with next-generation, AI-driven automation and predictive analytics. The… more
- Public Consulting Group (St. Paul, MN)
- …will demonstrate the capacity for developing training content, facilitating school-based Medicaid program concepts and being a key contributor to the development ... of a national training program for school-based Medicaid work across all states and the clients we...customer service requests via email and telephone regarding PCG systems , time studies, cost reports, and related processes and… more
- State of Minnesota (Vadnais Heights, MN)
- …a Revenue Integrity Manager! This position is part of a growing Revenue Cycle Management Team and will be responsible for ensuring compliance with the Centers for ... Medicare and Medicaid Services (CMS), State Medicaid (MA), Private...and coding regulations. + _This position serves as a Systems Administrator for DCT's patient accounting modules within the… more
- Highmark Health (St. Paul, MN)
- …the enterprise to respond to client questions and concerns about care/case management and high-cost claimants. + Gather information and develop ... across the enterprise, including but not limited to, Clinical Strategy, Sales/Client Management , Customer Service, Claims, and Medical Policy. The person in this… more
- Humana (St. Paul, MN)
- …pipelines, ensuring adherence to best practices in accountable AI for effective risk management and measurement. Join us in shaping the future of healthcare through ... Scientist to drive the safety, alignment, and ethical development of Agentic AI systems . You will lead initiatives to ensure our intelligent agents behave reliably,… more
- Humana (St. Paul, MN)
- …design, implementation, and advancement of strategic initiatives within the Utilization Management (UM) function. This role is responsible for leveraging data-driven ... actionable solutions to address opportunities for process improvement and cost management . Collaborate with clinical, actuarial, operations, and compliance teams to… more