- Robert Half Accountemps (Southampton, MA)
- Description We are offering an opportunity for a Medicaid Claims specialist in Southampton, Massachusetts. This role is within the healthcare industry and ... stationed in a dynamic workplace environment. Responsibilities: * Evaluate and process Medicaid claims with accuracy and efficiency. * Utilize your understanding… more
- Sumitomo Pharma (Hartford, CT)
- …resolve disputes and to clean up historical utilization that is routinely submitted with Medicaid claims . In addition, the analyst will load Medicaid claim ... highly motivated, and experienced individual for the position of **Analyst, Medicaid Rebates.** This individual contributor role is responsible for processing … more
- Insight Global (Hartford, CT)
- …background in the Medicaid or healthcare domain with experience in the claims provider area. This person should have experience working in a matrixed environment ... 7+ years of experience as an IT Business Analyst Domain experience within Medicaid or healthcare claims provider Strong expertise gathering and writing business… more
- Robert Half Finance & Accounting (Windsor, CT)
- …accounts receivable, and general ledger. + Ensure accurate and timely submission of Medicaid and Medicare claims , and manage follow-up and appeals as necessary. ... Business Office Manager, you will be responsible for managing Medicaid and Medicare billing, general ledger (GL) management, and...Long Term Care (LTC) billing and financial management, including Medicaid and Medicare, 5+ years at a minimum +… more
- Evolent Health (Hartford, CT)
- …+ 5-8+ years of IT and / or business experience in an HMO / PPO Claims , Medicaid , Medicare and / or managed care healthcare environment + Knowledge of the ... Affordable Care Act, HMO and managed care principles including Medicaid and Medicare regulation + Extensive experience with the System Design Life Cycle (SDLC) +… more
- Humana (Hartford, CT)
- …first** Humana Healthy Horizons is seeking exceptional candidates to join our Medicaid Product Strategy Organization to advance Humana's Medicaid products and ... capabilities to support the strategic direction and growth of the Medicaid and Duals lines of business. This is a unique opportunity for a motivated individual to… more
- Baylor Scott & White Health (Hartford, CT)
- **JOB SUMMARY** The Risk Adjustment Analyst Sr (Texas Medicaid Encounter Analyst) is responsible for monitoring and oversight of the end-to-end encounter management ... to government agencies such as Centers for Medicare and Medicaid Services (CMS) or Health & Human Services (HHS)....OF THE ROLE** + Monitors and oversees the end-to-end claims encounter management workflow. + Analyzes claims … more
- CVS Health (Hartford, CT)
- …onsite in Hartford, CT CVS Health is seeking a Senior Analyst to join our Medicaid Finance Central Reporting team. This role will function as the Senior Analyst for ... the Aetna Medicaid markets and will help the respective achieve its...Qualifications** 3+ years of experience with Finance and/or healthcare claims analyses **Preferred Qualifications** Experience with using Microsoft SQL… more
- Humana (Hartford, CT)
- …caring community and help us put health first** The Senior Pharmacy Claims Operations Professional oversees the business processes and ensures accuracy for pharmacy ... point of sale transition adjudicated claims logic. The Senior Pharmacy Claims Operations...a better quality of life for people with Medicare, Medicaid , families, individuals, military service personnel, and communities at… more
- Prime Therapeutics (Hartford, CT)
- …fuels our passion and drives every decision we make. **Job Posting Title** Claims Technical Analyst, Sr. **Job Description** The Senior Claims Technical Analyst ... is responsible for serving as the claims analysis resource for assigned operations teams. This role...with Medicare Part D and Centers for Medicare and Medicaid Services rules and regulations **Preferred Qualifications** + Training… more
- Humana (Hartford, CT)
- …of the managed care industry including Medicare Advantage, Managed Medicaid and/or Commercial products, or other Medical management organizations, hospitals/ ... in a medical management review organization, such as Medicare Advantage, managed Medicaid , or Commercial health insurance. + Experience with national guidelines such… more
- Trinity Health (West Springfield, MA)
- …PACE Programs. Performs various financial tasks for billing, revenue collection, Medicaid share of cost, member education, accounts receivable, accounts payable, ... claims , Medicare Part D reporting, member enrollment and disenrollment...(especially Excel) to perform job duties **Position Purpose** The Medicaid Eligibility Specialist supports participants and families through the… more
- CVS Health (Hartford, CT)
- …and long term strategic and operational objectives across Commercial, Medicare and Medicaid lines of business. The role is also accountable for achieving financial ... and performance targets as well as Commercial/Medicare/ Medicaid Scoreable Action Item (SAI) Management. Performance is measured against financial goals which include… more
- HealthEdge Software Inc (Hartford, CT)
- …implementing proprietary healthcare edits that drive cost savings and accuracy in claims processing. The successful candidate will be responsible for taking a senior ... level role in analyzing claims data, as well as translating contract terms, policies,...and enterprise level. Our Reimbursement Transformation features Medicare and Medicaid content coupled with flexible contract configuration capabilities for… more
- Humana (Hartford, CT)
- …operational efficiency, reduce manual processes, and improve accuracy in insurance claims processing, policy management, and other key areas. A strong background ... solutions to streamline and automate insurance-related processes, such as claims processing, policy administration, and customer service operations. + **Technical… more
- Humana (Hartford, CT)
- …first** The Medical Director relies on medical background and reviews health claims . The Medical Director work assignments involve moderately complex to complex ... of the managed care industry including Medicare Advantage, Managed Medicaid and/or Commercial products, or other Medical management organizations, hospitals/… more
- Prime Therapeutics (Hartford, CT)
- …data output using eligibility data, medical and pharmacy administrative claims . The individual will support pharmaceutical manufacturer value-based contract ... reports, scorecards, or other data using Pharmacy and/or Medical claims data to support projects and initiatives throughout the...& Analytics team, State Government Services (eg, Medicare and Medicaid ) team, and Specialty team and Clinical team +… more
- Prime Therapeutics (Hartford, CT)
- …and participates in committee review meetings within the Commercial, Medicare, Medicaid , and Health Insurance Marketplace for the assigned department. This position ... Programs, Compliance, Healthcare Reform, Legal, Networks, Clinical Operations, Paper Claims , Member Materials, IT, etc.) to ensure effective collaboration,… more
- Humana (Hartford, CT)
- …The Corporate Medical Director relies on medical background and reviews health claims and preservice appeals. The Corporate Medical Director works on problems of ... clinical experience + Knowledge of the managed care industry including Medicare, Medicaid and or Commercial products + Must be passionate about contributing to… more
- Fallon Health (Springfield, MA)
- …be the leading provider of government-sponsored health insurance programs-including Medicare, Medicaid , and PACE- in the region. **Brief summary of purpose:** Works ... absence of the Site Director. Oversees the timely and accurate processing of claims , data collection and reporting including those related to the Electronic Medical… more