- State of Minnesota (St. Paul, MN)
- **Working Title: Medicaid Management Information Systems (MMIS) Supervisor** **Job Class: Systems Supervisor** **Agency: Minnesota IT Services** + ... illness, chemical dependencies, and physical or developmental disabilities. As the Medicaid Management Information Systems Supervisor, you will supervise… more
- 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)
- …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
- Humana (St. Paul, MN)
- …system. Ensure all paperwork and documentation is notated within the clinical management system. + ASN with care coordination efforts of assigned beneficiary ... permanent status. Ensure documentation is accurate and documented in all applicable systems . Be able to communicate ECHO requirements to beneficiaries to ensure they… more
- Cognizant (St. Paul, MN)
- …Medicaid , and third-party guidelines. + Effectively document and log claims/appeals information on relevant tracking systems + Utilize critical thinking ... by performing advanced level work related to clinical denial management and managing clinical denials from Providers to the...Plan **_Disclaimer_** : The salary, other compensation, and benefits information is accurate as of the date of this… 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. * Assists in the implementation of new products and systems by providing actionable information and recommendations that evaluate the ... requires expertise in healthcare data-including claims, membership, and provider information -along with hands-on experience in risk adjustment models, HCC analysis,… more
- Humana (St. Paul, MN)
- …Manager 2 supports implementation of government and industry policies for requirements management , document management , change management , production and ... where needed. Follows established guidelines/procedures. + Develops productive relationships with Medicaid operations IT, the data warehouse team, and users of data… 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
- 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)
- …health first** The Payment Integrity Coding Professional within Code Edit Vendor Management (CEVM) contributes to overall cost reduction by utilizing code editing ... and interpreting claims + Exceptional understanding of Centers for Medicare & Medicaid Services (CMS) guidelines, state Medicaid guidelines, correct coding… 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)
- …focus on the people side of change, including changes to business processes, systems and technology, job roles and organization structures. * Apply a structured ... methodology and change management tools to advise client on strategy to support...training activities related to MEMS Modules, MMIS Core Solutions, Medicaid DSS/DW and SI. * Prepare change impact assessments,… 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