• NYC Health Hospitals (New York, NY)
    …information and be familiar with claim coding practices and industry issues in Medicare payment methodologies. Advance level experience with Excel and other data ... comprehensive list of products, including, but not limited to, New York State Medicaid Managed Care, Medicare , Child Health Plus, Exchange, Partnership in Care,… more
    Upward (07/29/25)
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  • Medicare / Medicaid Claims Editing…

    Commonwealth Care Alliance (Boston, MA)
    …as necessary on all new and revised coding logic, related Medicare / Medicaid policies for review/approval through the Payment Integrity governance process. ... public health care programs and reimbursement methodologies ( Medicaid and Medicare ) + Medical Coding, Compliance, Payment Integrity and Analytics +… more
    Commonwealth Care Alliance (05/28/25)
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  • Medicare / Medicaid Claims…

    Commonwealth Care Alliance (Boston, MA)
    …and disputes. The Claims Sr. Analyst serves as a subject matter expert on Medicaid (MassHealth), Medicare , and commercial payment methodologies and supports ... and fee schedule issues. + Collaborate closely with Provider Relations, Contracting, Payment Integrity, Appeals & Grievances, and Configuration teams to validate… more
    Commonwealth Care Alliance (05/31/25)
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  • Senior Business Analyst - Emphasis on Nebraska…

    Molina Healthcare (Grand Island, NE)
    …Experience navigating Nebraska state and Medicare regulations related to claims configuration and payment accuracy. To all current Molina employees: If you ... of business analysis experience with an emphasis in claims payment accuracy and claims service recovery resolutions + 6+...Experience working with complex, often highly technical teams + Medicaid primary and Medicare preferable payer claims… more
    Molina Healthcare (07/24/25)
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  • Billing Operations Representative III - Hybrid

    Fallon Health (Worcester, MA)
    …strive to be the leading provider of government-sponsored health insurance programs-including Medicare , Medicaid , and PACE (Program of All-Inclusive Care for the ... all regulatory products. Responsible to reconcile the accuracy of payment file received from online premium payment ...P&P's + Serve as resource to other areas for Medicare and Medicaid questions/issues + Assists Management… more
    Fallon Health (07/25/25)
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  • Senior Manager, Government Pricing & Contracting

    BeOne Medicines (San Mateo, CA)
    …+ Experience successfully launching new drugs across all government programs, knowledge of Medicaid and Medicare Parts B and D inflation rebates, line extension ... of BeOne's price reporting and contracting obligations under the Medicaid Drug Rebate Program (MDRP), 340B Drug Discount Program,... Drug Rebate Program (MDRP), 340B Drug Discount Program, Medicare Part B ASP Reporting, Medicare Part… more
    BeOne Medicines (07/09/25)
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  • AVP, Health Plan Operations (Connecticut)

    Molina Healthcare (Hartford, CT)
    …* This position plans, organizes, staffs, and coordinates the operations of state Medicaid , Medicare and Marketplace Health Plan operations. * Works with staff ... the functionality of Health Plan Operations. * Directly manages the Plan's benefit configuration , claim payment policies and the maintenance or modification of… more
    Molina Healthcare (06/25/25)
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  • Reimbursement Analyst - REMOTE

    Molina Healthcare (Omaha, NE)
    …Information Management. **Job Duties** + Research, review, and decipher state-specific Medicaid and Medicare reimbursement methodologies for providers, including ... bundled payments (APG, EAPG, APR-DRG, MS-DRG, etc.). This role is within the Configuration Solution Support team which falls under the Core Operations team for… more
    Molina Healthcare (07/18/25)
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  • Senior Revenue Cycle Specialist

    Stony Brook University (East Setauket, NY)
    …Managed Care payment variances and denials. + Expert knowledge of Medicare and NY Medicaid Inpatient and Outpatient reimbursement methodologies. + Expert ... leader in the Hospital's Business Office to analyze, track, and pursue the payment of underpaid and denied accounts receivable. Successful candidates will have a… more
    Stony Brook University (07/02/25)
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  • Lead Cloud Network Engineer

    Humana (Topeka, KS)
    …efforts are leading to a better quality of life for people with Medicare , Medicaid , families, individuals, military service personnel, and communities at large. ... of escalation in response to incidents/requests regarding network performance and configuration , including off hours escalations + Manage vendors and service… more
    Humana (07/10/25)
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  • Director, MIG Operations - Michigan - McLaren…

    McLaren Health Care (Flint, MI)
    …our Indiana-based health plan, working with the State of Indiana and Centers for Medicare and Medicaid Services to bring you the Hoosier Healthwise and Healthy ... Two (2) years' experience in claims and enrollment system configuration and maintenance. + Two (2) years' experience in... and maintenance. + Two (2) years' experience in payment integrity, claims editing and recovery operations. + Affiliation… more
    McLaren Health Care (07/29/25)
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  • Marketing Automation Manager (Adobe AEP/NBA)

    Humana (Sacramento, CA)
    …efforts are leading to a better quality of life for people with Medicare , Medicaid , families, individuals, military service personnel, and communities at large. ... or lifecycle marketing experience + 2+ years of hands-on configuration experience with Adobe Journey Optimizer and Adobe Experience...Montana, or South Dakota will be provided a bi-weekly payment for their internet expense. + Humana will provide… more
    Humana (07/24/25)
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  • VP, Network Mgmt & Ops (Ohio Health Plan)

    Molina Healthcare (Dayton, OH)
    …area to ensure accuracy of provider information in support of accurate configuration for claims payment . **JOB QUALIFICATIONS** **Required Education** Bachelor's ... in Business, Health Administration, or related field. **Preferred Experience** Experience with Medicaid and Medicare managed care plans. \#PJHPO \#LI-AC1 To all… more
    Molina Healthcare (07/23/25)
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  • Senior Offensive Security Engineer

    Humana (Annapolis, MD)
    …efforts are leading to a better quality of life for people with Medicare , Medicaid , families, individuals, military service personnel, and communities at large. ... analyze and evaluate variable factors such as network architecture, agent configuration , and detection capabilities. + **Strategic Collaboration** : Collaborate with… more
    Humana (07/22/25)
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