- Humana (Frankfort, KY)
- …governmental requirements as they relate to Medicaid State reporting. The Senior Compliance Professional work assignments involve moderately complex to ... our caring community and help us put health first** Senior Compliance Professional ensures ...for project components . Managing state reporting for assigned Medicaid market(s) (contracts and gathering data for reports) **Use… more
- Humana (Richmond, VA)
- …contracts and agreements within the Virginia Medicaid space. The Senior Provider Contracting Professional work assignments involve moderately complex to ... part of our caring community and help us put health first** The Senior Provider Contracting Professional initiates, negotiates, and executes physician, hospital,… more
- Humana (Columbus, OH)
- …a part of our caring community and help us put health first** This Senior Fraud and Waste Investigator will serve as Humana's Program Integrity Officer, who will ... and enforcement of the fraud, waste, and abuse (FWA) compliance program to prevent and detect potential FWA activities...primary point of contact for the Ohio Department of Medicaid (ODM) and other agencies such as the … 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
- 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
- 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 (Juneau, AK)
- …a part of our caring community and help us put health first** The Senior Encounter Data Management Professional develops business processes to ensure successful ... submissions to Medicaid /Medicare. Ensures encounter submissions meet or exceed all compliance standards via analysis of data, and develops tools to enhance the… more
- Prime Therapeutics (Pierre, SD)
- …care experience related to Medicare, Medicaid , Commercial, HIM + Certified Compliance and Ethics Professional (CCEP) or Certified Healthcare Compliance ... and drives every decision we make. **Job Posting Title** Senior Compliance Analyst (Risk Assessment and Oversight)...or other highly regulated industry, including experience with Medicare, Medicaid , and the Affordable Care Act (ACA) + Must… more
- Humana (Detroit, 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
- Banner Health (AZ)
- …ready to change lives, we want to hear from you. Seeking an experienced compliance professional with knowledge of and experience in managing a Conflicts of ... knowledge of laws and regulations pertaining to health care, regulatory compliance , Medicare/ Medicaid and/or financial reimbursement systems. Must possess strong… more
- Humana (Little Rock, AR)
- …to the compliance and commissions of Humana external producers. The Senior Agency Professional ; Finance & Accounting. work assignments involve moderately ... caring community and help us put health first** The Senior Agency Professional ; Finance & Accounting supports...; Finance & Accounting supports data analysis related to compliance and commissions for Humana's external producers. The role… 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 (Austin, TX)
- …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
- MyFlorida (Tallahassee, FL)
- 68064926 - SENIOR INFO TECH BUSINESS CONSULTANT / TECHNICAL WRITER & COMMUNICATIONS Date: Sep 26, 2025 The State Personnel System is an E-Verify employer. For more ... No: 861515 Agency: Agency for Health Care Administration Working Title: 68064926 - SENIOR INFO TECH BUSINESS CONSULTANT / TECHNICAL WRITER & COMMUNICATIONS Pay Plan:… more
- Molina Healthcare (Naperville, IL)
- …and implementation of NCQA accreditation surveys and federal/state QI compliance activities. **KNOWLEDGE/SKILLS/ABILITIES** The Senior Specialist, Quality ... more of these quality improvement functions: Quality Interventions and Quality Improvement Compliance . + Acts as a lead specialist to provide project-, program-, and… more
- Humana (Olympia, WA)
- …part of our caring community and help us put health first** The Senior Provider Contracting Professional initiates, negotiates, and executes physician, hospital, ... and agreements for an organization that provides health insurance. The Senior Provider Contracting Professional work assignments involve moderately complex… more
- Humana (Juneau, AK)
- …to put those customers at the center of everything it does." The Senior Organization Effectiveness Professional optimizes the effectiveness of a company, ... maximize employee work output and effectively utilize employee skills. The Senior Organization Effectiveness Professional work assignments involve moderately… more
- University of Rochester (Brighton, NY)
- …+ Collaborates closely with the Medical Center's Office of Integrity and + Compliance , providing analysis and legal advice to senior leadership on billing ... the goals and expectations established for the Office of Counsel, the Senior Counsel identifies, analyzes and provides legal guidance and services on complex… more
- Humana (Indianapolis, IN)
- …a part of our caring community and help us put health first** The Senior Market Development Professional will be instrumental in driving the Midwest Region's ... be key, as well as, partnering effectively with stakeholders across Humana. The Senior Market Development Professional will be instrumental in driving the… more