- CVS Health (Raleigh, NC)
- …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 (Raleigh, NC)
- …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
- Humana (Raleigh, NC)
- …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
- CVS Health (Raleigh, NC)
- …the process for identifying, evaluating, and completing contracting with Specialty and Medicaid provider partners. . Developing relationships with leaders of ... chronic kidney, oncology, polychronic/complex care, and emerging specialty types) or Medicaid provider organizations to design and execute on strategies… more
- CenterWell (Raleigh, NC)
- …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
- CVS Health (Raleigh, NC)
- …of business systems, applications, and tools supporting network management, contracting, and provider data systems + Experience in related business environment ... audits out of QNXT and PRMS systems to support Medicaid SOC and SOX controls + Coordinate with applicable...with exposure to provider data , processes, etc. **Education** Bachelor's degree… more
- Humana (Raleigh, NC)
- …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 (Raleigh, NC)
- …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 (Raleigh, NC)
- …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 (Raleigh, NC)
- …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 (Raleigh, NC)
- …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 (Raleigh, NC)
- ** 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
- CVS Health (Raleigh, NC)
- …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 (Durham, NC)
- …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...will make an impact** : + Analyzes and interprets data and makes recommendations for change based on judgment… more
- UNC Health Care (Chapel Hill, NC)
- …in order to complete 485 and OASIS appropriately. 2. Assesses and interprets patient data as needed to provide guidance to Case Managers on patient needs ... care clinical staff to ensure it is compliant with Medicare, Medicaid /state/federal regulations, and agency policies and guidelines; works closely with Performance… more
- CenterWell (Raleigh, NC)
- …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 (Raleigh, NC)
- …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 (Durham, NC)
- …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
- CenterWell (Raleigh, NC)
- …diagnosis codes that are submitted to the Centers for Medicare and Medicaid Services (CMS) and other government agencies. The Program Management Lead, Offshore ... needed. + Participate in Payer calls/chart reviews. + May participate in provider education programs on coding compliance. + Exercises independent judgment and… more
- Elevance Health (Durham, NC)
- …_We are partnering with North Carolina DHHS to operationalize a statewide Medicaid Plan designed to support Medicaid -enrolled infants, children, youth, young ... required by law._ The Delegated Care Management Monitor (Special Programs Case Manager II) is responsible for overseeing and monitoring healthcare services to insure… more