• CGI (Fairfax, VA)
    Lead Business Analyst Category: Business Analysis (functional and technical) Main location: United States, Virginia, Fairfax Alternate Location(s): United ... more. Position Description: CGI Federal is seeking a Lead Business Analyst to help lead the Department...Department of Health and Human Services (HHS), Centers for Medicare and Medicaid Services (CMS) Next Generation… more
    Upward (07/03/25)
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  • Innova solutions (Red Bank, NJ)
    …the various Hold/Pend codes used in healthcare claims across payers and lines of business (commercial, Medicare , Medicaid ). Identify root causes for claim ... Innova Solutions is immediately hiring a Lead Business Analyst Position type: Permanent Duration: Fulltime Location: New Jersey, US As a Lead Business more
    Upward (07/06/25)
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  • Compunnel (Louisville, KY)
    Job Summary: We are seeking a detail-oriented and analytical Business Analyst to support initiatives in the healthcare payor domain, specifically within ... Medicare and/or Medicaid . The ideal candidate will...collaboration to ensure alignment across teams. Key Responsibilities: Prepare business and technical scope documentation and impact assessments in… more
    Upward (07/28/25)
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  • NYC Health Hospitals (New York, NY)
    …comprehensive list of products, including, but not limited to, New York State Medicaid Managed Care, Medicare , Child Health Plus, Exchange, Partnership in Care, ... Yorkers to live their healthiest life. Position Overview The Payment Integrity (PI) Analyst will assist in the development of a strategic roadmap to recover,… more
    Upward (07/29/25)
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  • Waystar (Louisville, KY)
    …1K+ hospitals and health systems, and is connected to over 5K commercial and Medicaid / Medicare payers. We are deeply committed to living out our organizational ... in this position are expected to develop a broad knowledge of Waystar's business , industry, and operations in order to support analysis and decision making. WHAT… more
    Upward (07/05/25)
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  • eSimplicity (Columbia, MD)
    …and drill down to get details as needed Collaborate with the development and analyst to ensure implementation of the needed business , functional, and system ... in software development in an agile environment Strong experience with the Centers for Medicare and Medicaid Services (CMS) and/or Medicaid CHIP data Test… more
    Upward (07/12/25)
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  • Indiana University Health (Indianapolis, IN)
    …This role offers an exciting opportunity to work on both 340B and Medicare / Medicaid reimbursement initiatives, helping to grow our programs and optimize ... Communicate and resolve conflicts with physicians, healthcare team members, business /managed care/governmental agencies, insurance company representatives, self-funded employer decision… more
    Upward (07/11/25)
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  • Medicare / Medicaid Claims Editing…

    Commonwealth Care Alliance (Boston, MA)
    …This role will ensure that the applicable edits are compliant with applicable Medicare and Massachusetts Medicaid regulations. The role will also be responsible ... research, as necessary on all new and revised coding logic, related Medicare / Medicaid policies for review/approval through the Payment Integrity governance… more
    Commonwealth Care Alliance (05/28/25)
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  • Medicaid Provider Hospital Reimbursement…

    Humana (Santa Fe, NM)
    …and help us put health first** The Medicaid (PPS) Provider Hospital Reimbursement Analyst also known as a Senior Business Intelligence Engineer will be an ... complex Medicaid provider reimbursement methodologies. The associate will support existing Medicaid business and expansion into new states. The business more
    Humana (07/29/25)
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  • Sr Medicaid Reimbursement Regulatory…

    Zelis (Plano, TX)
    …the personal interests that shape who you are. Position Overview The Sr. Medicaid Reimbursement Regulatory Analyst will collaborate with the Zelis Regulatory ... communicating rules, regulations, and procedures pertaining to public and private Medicaid payment systems. This position requires an in-depth knowledge of… more
    Zelis (07/12/25)
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  • Senior Business Analyst - Emphasis…

    Molina Healthcare (Grand Island, NE)
    …interaction experience + Experience working with complex, often highly technical teams + Medicaid primary and Medicare preferable payer claims experience + QNXT ... on complex claims related issues and service recovery efforts.** Analyzes complex business problems and issues using data from internal and external sources to… more
    Molina Healthcare (07/24/25)
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  • Medicare Risk Adjustment Actuarial…

    Elevance Health (Mendota Heights, MN)
    ​ ** Medicare Risk Adjustment Actuarial Analyst III** **On-Site Requirement: Hybrid 1;** **This role requires associates to be in-office 1 - 2 days per week,** ... an accommodation is granted as required by law._ The ** Medicare Risk Adjustment Actuarial Analyst III** is...complex projects related to risk adjustment analytics in the Medicare Advantage line of business . **How You… more
    Elevance Health (07/18/25)
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  • Senior Internal Auditor ( Medicare

    CVS Health (Hartford, CT)
    …we do it all with heart, each and every day. **Position Summary:** + The Sr Analyst , Internal Audit will be a key member of the Internal Audit team and will ... controls, implementing audit tests, and communicating with / reporting audit findings to business line management. + CVS Health follows a hybrid work model providing… more
    CVS Health (07/03/25)
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  • Lead Business Analyst

    CGI Technologies and Solutions, Inc. (Fairfax, VA)
    **Lead Business Analyst ** **Category:** Business Analysis (functional and technical) **Main location:** United States, Virginia, Fairfax **Alternate ... . **Position Description:** CGI Federal is seeking a Lead Business Analyst to help lead the Department...Department of Health and Human Services (HHS), Centers for Medicare and Medicaid Services (CMS) Next Generation… more
    CGI Technologies and Solutions, Inc. (05/31/25)
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  • Coding Specialist - Medicare

    BlueCross BlueShield of North Carolina (NC)
    …practices with complex coding patterns and reports relevant data to the Centers for Medicare and Medicaid Services (CMS). **What You'll Do** + Analyzes necessary ... coding and reports relevant data to the Centers for Medicare and Medicaid Services (CMS). + Uses...training, specialized skill sets, licensure and certifications and other business and organizational needs. Our base salary is part… more
    BlueCross BlueShield of North Carolina (07/23/25)
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  • Sr Reimbursement Analyst

    CommonSpirit Health (Phoenix, AZ)
    …reimbursement services of Dignity Health. The position maintains current knowledge of Medicare Medicaid and other State and Federal regulations. The Sr. ... Managers and/or Directors. Accountabilities: Prepares interim and annual cost reports for Medicare Medicaid and other State or Federal agencies for Dignity… more
    CommonSpirit Health (07/29/25)
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  • Sr. Business Systems Analyst

    Prime Therapeutics (Eagan, MN)
    …It fuels our passion and drives every decision we make. **Job Posting Title** Sr. Business Systems Analyst **Job Description** The Sr. Business Systems ... organization objectives by acting as the bridge between the business systems analyst team, business ...Benefit Management (PBM) or healthcare experience with understanding of Medicare , Medicaid , the Exchanges along with regulatory… more
    Prime Therapeutics (07/25/25)
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  • Reimbursement Analyst

    Tidelands Health (Pawleys Island, SC)
    … will ensure timely and accurate reporting of all regulatory financial information to Medicare & Medicaid . This position requires the ability to manage strict ... is not limited to: IRS Form 990 Schedule H; Medicare , Medicaid & Tricare Cost Reports; ...years of progressive healthcare experience working as a Reimbursement Analyst in a hospital, a Medicare Administrative… more
    Tidelands Health (05/20/25)
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  • Sr Reimbursement Analyst

    CommonSpirit Health (Phoenix, AZ)
    …reimbursement services of Dignity Health. The position maintains current knowledge of Medicare , Medicaid and other State and Federal regulations. The Sr. ... Analyst also assists in the improvement of internal business processes and meeting future reimbursement service needs. The...Accountabilities: 1. Prepares interim and annual cost reports for Medicare , Medicaid and other State or Federal… more
    CommonSpirit Health (07/22/25)
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  • Application Analyst III - Core

    NTT DATA North America (Merced, CA)
    Medicaid Program, the methods of product configuration in a Medicaid / Medicare environment, and medical terminology, related procedures, and national ... DATA have focused on impacting the core of your business operations with industry-leading outsourcing services and automation. With...strategy NTT DATA currently seeks a direct hire Application Analyst III - Core to join our team in… more
    NTT DATA North America (07/24/25)
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