- 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 (Washington, DC)
- …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 (Washington, DC)
- …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
- CenterWell (Washington, DC)
- …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 (Washington, DC)
- …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 (Washington, DC)
- …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
- Erickson Living (Springfield, VA)
- Location: Greenspring Village by Erickson Senior Living The Health Care Sales Manager is responsible for managing the health care sales team to develop and maintain ... ensure accurate knowledge of the competitive landscape. + Maintain market intelligence data and collaborates with ESL Home Office partners to build quarterly market… more
- Cardinal Health (Washington, DC)
- …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 (Washington, DC)
- …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
- Capital One (Mclean, VA)
- …loan forbearance programs and Medicaid on consumer financial health. As a Senior Manager on the team, you will be a people leader for 2+ associates, as well ... Sr. Manager , Consumer Intelligence - Corporate Strategy **Description:** Founded...the team in getting the most from our existing data , as well as writing new surveys to uncover… 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
- Datavant (Washington, DC)
- …needs, and determine the right methodology for analysis and assumptions to provide data -driven insights into program performance and partnerships + Create ... + Run various risk adjustment models for Medicare Advantage, Medicaid or ACA to forecast patient risk scores and...problem-solving skills with the ability to think critically and provide data -driven solutions + Expertise in the… 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
- CenterWell (Washington, DC)
- …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 (Washington, DC)
- …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
- CenterWell (Washington, DC)
- …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 (Hanover, MD)
- …performing complex actuarial studies related to risk adjustment analytics in both the Medicaid and Medicare Advantage lines of business. **How You Will Make an ... Analyzes and develops SAS and SQL programming to support Medicaid and Medicare Advantage risk adjustment initiatives. + Performs... and Medicare Advantage risk adjustment initiatives. + Performs data mining and data -driven analyses to evaluate… more