- Sun Pharmaceuticals, Inc (Washington, DC)
- …developed analytical skills with demonstrated ability to conceptualize issues and synthesize data to provide strategic direction Experience in Sun Pharmas ... Field Reimbursement Manager Overview: The Field Reimbursement Manager ...(coverage, coding & payment), specialty pharmacy and distribution processes, provider support services (eg, benefits investigation) and patient support… more
- 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
- 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 (Annapolis, MD)
- …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 (Annapolis, MD)
- …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 (Annapolis, MD)
- …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
- Elevance Health (Washington, DC)
- …promoting a dynamic and adaptable workplace._ Responsible for supporting the Medicaid Medical Management team by managing and overseeing non-clinical medical ... programs for staff involved in the program. + Extracts and manipulates analytical data to present findings to relevant markets and stakeholders. + Hires, trains,… more
- Cardinal Health (Annapolis, MD)
- …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 (Annapolis, MD)
- …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 (Annapolis, MD)
- …at the center of everything it does. We are seeking a Lead Product Manager to drive the vision, strategy, and execution of our Sales and Marketing Technology ... our sales and marketing teams to achieve growth targets. The Lead Product Manager Conceives of, develops, delivers, and manages products for customer use. The Lead… 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 (Annapolis, MD)
- …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 (Annapolis, MD)
- …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 (Annapolis, MD)
- …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
- CenterWell (Annapolis, MD)
- …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
- Johns Hopkins University (Washington, DC)
- …daily printed schedules for designated areas. + Obtain and/or verify patient's demographic data by phone or in person. + Confirm appointments by telephone and/or ... resources for further information, guidance, or assistance. + Answer phones and provide routine information to callers. + Collect time of service payments, issues… more
- Cardinal Health (Annapolis, MD)
- …appealing and compelling communications (infographics, Veeva Engage posts, slides, manager huddle scripts) tailored to diverse audiences-from frontline teams to ... mitigation strategies to keep business and AI transformation momentum strong. Leverage data and insights to refine approaches. . Contribute to the evolution of… more
- Public Consulting Group (Annapolis, MD)
- …agency and school district clients in their efforts related to special education, Medicaid reimbursement, data management and use. While a remote role, it ... the State of Washington and the Pacific Northwest. The Senior Consultant will provide local leadership, partnership, and expertise in supporting state education… more
