- Humana (Springfield, IL)
- **Become a part of our caring community and help us put health first** The Senior Data and Reporting Professional generates ad hoc reports and regular datasets ... using system tools and database or data warehouse queries and scripts. The Senior Data and Reporting Professional work assignments involve moderately complex to… more
- Centene Corporation (Jefferson City, MO)
- …analytics preferred. Certified in HealthCare Compliance (CHC) preferred. Certified Compliance & Ethics Professional (CCEP) preferred. Pay Range: $68,700.00 - ... lines of business. Responsibilities include intaking and triaging suspected issues of non- compliance , entry of compliance issues into GRC tool and… more
- Prime Healthcare (Ontario, CA)
- …actively seeking new members to join our corporate team! Responsibilities The Senior Medicare- Medicaid Biller/Collector is responsible for both billing and ... in accordance with the specific payer guidelines, policies, procedures, and compliance regulations for Medicare- Medicaid . This includes maintaining the… more
- Elevance Health (Grand Prairie, TX)
- **Business Information Analyst Senior - Medicaid Encounters Data** The **Business Information Analyst Senior ** is responsible for analyzing and validating ... validate Medicaid encounter data submissions for accuracy, completeness, and compliance with CMS requirements. + Collaborate with internal teams to gather… more
- CVS Health (Downers Grove, IL)
- …utilization/performance, network growth, and efficiency targets. Manages and oversees compliance within our network responsibilities as provided within the state ... Medicaid contractual requirements. This position holds a variety of...have access to necessary resources, training, and support for compliance and operational success. Develop and implement training programs… more
- Humana (Hartford, CT)
- …claims operations, and other business teams involved in the administration of Medicaid business at Humana. The Senior Business Intelligence Engineer will ... development; and + Creating and executing comprehensive test plans + Ongoing Medicaid pricer maintenance, quality assurance, and compliance + Determining root… more
- Louisiana Department of State Civil Service (Baton Rouge, LA)
- …compliance with complex state and federal regulations governing more than 30 Medicaid programs. + Supervises senior managers and staff, setting performance ... DEPUTY DIRECTOR OF ELIGIBILITY ( MEDICAID DEPUTY DIRECTOR) Print (https://www.governmentjobs.com/careers/louisiana/jobs/newprint/5062744) Apply DEPUTY DIRECTOR OF… more
- Prime Healthcare (Redding, CA)
- …their family. For more information, visit www.shastaregional.com . Responsibilities The Senior Medicare- Medicaid Biller/Collector is responsible for both billing ... in accordance with the specific payer guidelines, policies, procedures, and compliance regulations for Medicare- Medicaid . This includes maintaining the… more
- Humana (Lansing, MI)
- …Clinical Pharmacy Lead, plans, directs, and monitors all financial, operational, professional , and clinical activities for the purposes of pharmacy program ... Fully Integrated Dual Eligible Special Needs Plan (FIDE-SNP) Michigan Medicare - Medicaid health plan. The individual leverages a broad understanding of managed care… more
- Mount Sinai Health System (New York, NY)
- …and Ancillary Contracts across the Mount Sinai Health System. MSHP seeks a Senior Contract Compliance ( Professional Billing) Analyst who will primarily ... to Facility Contracts for all Commercial, Medicare Advantage and Medicaid Managed Care Plans. The team serves as MSHP's...be responsible for tracking, trending, and analyzing professional billing (PB) contract compliance issues. This… more
- Humana (Olympia, WA)
- …providing frameworks to maximize available resources to achieve growth. The ** Senior Professional Business Intelligence Engineer** is an experienced individual ... meet compliance requirements and define and drive business value. The Senior Professional will partner across various multi-disciplinary teams at Humana to… more
- Humana (Indianapolis, IN)
- …a part of our caring community and help us put health first** The Senior Quality Compliance Professional completes annual quality reviews and research. ... The Senior Quality Compliance Professional work assignments involve moderately complex...a better quality of life for people with Medicare, Medicaid , families, individuals, military service personnel, and communities at… more
- Humana (Charleston, WV)
- …between Humana and its trading partners, Medicare and Medicaid . The Senior Encounter Data Management Professional will work with department leadership, ... a part of our caring community and help us put health first** The Senior Encounter Data Management Professional develops business processes to ensure successful… more
- Humana (Lansing, MI)
- **Become a part of our caring community and help us put health first** The Senior Claims Research and Resolution Professional reports to the Claims Research and ... strategy and operating objectives, including their applications to assignments. The Senior Claims Research and Resolution Professional follows general guidance… more
- Humana (Lansing, MI)
- …part of our caring community and help us put health first** The Senior Provider Relations Professional is responsible for fostering positive, long-term ... relationships with network providers that participate in Michigan's Humana Medicaid Program. Day-to-day work includes conducting provider orientations and… more
- Staffing Solutions Organization (Albany, NY)
- …have professional experience in public health insurance programs, including Medicaid , Medicare and/or Child Health Plus. Preferred candidates will also have ... reflection of our clients and the people they serve. ** Senior Healthcare Program Specialist (Level 2 or 3) -...of Eligibility & Marketplace Integration (DEMI)** **Bureau of Program Compliance and Audit** **50% Onsite 50% Remote** **Duties:** The… more
- Humana (Lansing, MI)
- **Become a part of our caring community and help us put health first** The Senior Data and Reporting Professional ( Medicaid - Michigan) generates ad-hoc ... Humana's Michigan Medicaid plan network optimization. The Senior Data and Reporting Professional integrates data...the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and… more
- Baylor Scott & White Health (Dover, DE)
- …ensure compliance with BSWH policies and CMS and Texas Medicaid regulations, providing reports, recommendations, and corrective action follow-up. Monitors trends ... completed in a timely way. . Responds to inquiries utilizing applicable Medicare and Medicaid guidance. Serves as a compliance resource to BSWH departments and… more
- Baylor Scott & White Health (Salt Lake City, UT)
- …ESSENTIAL FUNCTIONS OF THE ROLE This position will be supporting Hospital and Professional areas of billing compliance : . Conducts audits and assessments to ... ensure compliance with BSWH policies and CMS and Texas Medicaid regulations, providing reports, recommendations, and corrective action follow-up. Monitors trends… more
- MyFlorida (Tallahassee, FL)
- 68064839 - SENIOR DATA BASE ANALYST Date: Aug 29, 2025 The State Personnel System is an E-Verify employer. For more information click on our E-Verify Website ... 859830 Agency: Agency for Health Care Administration Working Title: 68064839 - SENIOR DATA BASE ANALYST Pay Plan: Career Service Position Number: 68064839 Salary:… more