- Humana (Harrisburg, PA)
- …a part of our caring community and help us put health first** The Medicaid (PPS) Provider Hospital Reimbursement Analyst also known as a Senior Business Intelligence ... Pricer Business and System Support team responsible for administering complex Medicaid provider reimbursement methodologies. The associate will support existing … more
- CenterWell (Harrisburg, PA)
- …a part of our caring community and help us put health first** The Medicaid Drug Strategy Pharmacist Lead requires a broad understanding of pharmacy, managed care, ... drug strategies to mitigate cost trend and improve health outcomes. The Medicaid Drug Strategy Pharmacist Lead work assignments involve moderately complex to complex… more
- Humana (Harrisburg, PA)
- …of financial operations for Humana's Michigan HIDE Plan with a focus on Medicaid and state partnership, oversees the budget, financial reporting, and all audit ... **Key Responsibilities** + Provides market specific financial leadership in the State Medicaid Market, developing a deep understanding of Humana's Medicaid … more
- Genesis Healthcare (Philadelphia, PA)
- …a meaningful impact in the communities we serve. Responsibilities The National Medicaid Eligibility Advisor is the subject matter expert on Revenue Cycle Management ... Medicaid Eligibility and strives to improve the quality of...to improve the quality of all revenue cycle management Medicaid Eligibility related functions, from patient pre-admission to discharge,… more
- Humana (Harrisburg, PA)
- …a part of our caring community and help us put health first** The Medicaid Pricing Actuary provides actuarial support across a broad range of actuarial and business ... needs for Medicaid product lines. The Actuary works on problems of...scope and complexity ranging from moderate to substantial. The Medicaid Pricing Actuary may be responsible for any combination… more
- Humana (Harrisburg, PA)
- …support across a broad range of actuarial, managerial, and business needs for Medicaid -specific product lines. The Lead Actuary will serve as a project manager in ... review and documentation. The Lead Actuary will be responsible for Medicaid -specific functions such as capitation rate review, drafting rate advocacy communications,… more
- Humana (Harrisburg, PA)
- …of our caring community and help us put health first** The Medicaid Lead, Technology Solutions builds strategic partnerships and manages relationships between IT ... strategy. **This State Technology Lead role will cover the Michigan Medicaid /DSNP product lines along with one additional state.** **Responsibilities** **Market… more
- Prime Therapeutics (Harrisburg, PA)
- …we make. **Job Posting Title** IT Business Systems Analyst Sr - Medicaid Pharmacy Implementations - Remote **Job Description** The IT Business Systems Analyst ... Benefit Management (PBM) or healthcare experience with understanding of Medicare, Medicaid , the Exchanges along with regulatory compliance requirements (HIPAA and/or… more
- CVS Health (Harrisburg, PA)
- …for high volume inbound provider calls for the Claims Inquiry/Claims Research Medicaid team. Extensive claims research on multiple platforms to assist providers with ... payment questions. + Educate provider with related information to answer the unasked questions, eg, additional plan details, benefit plan details, provider self-service tools, etc. + Use customer service threshold framework to make financial decisions to… more
- Highmark Health (Pittsburgh, PA)
- …solutions with seamless omni-channel handoffs. As a key leader of the Medicaid Clinical organization, role is responsible for maximizing and optimizing value of ... the programs through delivery and as such, is accountable for customer activation, engagement, and experience, quality delivery, health outcomes, care cost management, and operational excellence/administrative cost management. This requires the incumbent to… more