• MBA Intern - Illinois Medicaid (Part-time,…

    Humana (Phoenix, AZ)
    …+ Experience in consulting and healthcare industry, preferably in Medicare and/or Medicaid + Professional experience in finance , clinical quality, innovation, ... caring community and help us put health first** The MBA Intern - Illinois Medicaid (Part-time, Fall 2025) will contribute as a team member while completing a… more
    Humana (08/02/25)
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  • Medicaid Business Intelligence Engineer

    Humana (Phoenix, AZ)
    …a part of our caring community and help us put health first** A Medicaid Business Intelligence Engineer solves complex business problems and issues using data from ... and independent determination of the appropriate courses of action. Medicaid Business Intelligence Engineer describes the tools, technologies, applications and… more
    Humana (08/14/25)
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  • Encounter Data Management Professional

    Humana (Phoenix, AZ)
    …ensure successful submission and reconciliation of encounter submissions to Medicaid /Medicare. Ensures encounter submissions meet or exceed all compliance standards ... and develops tools to enhance the encounter acceptance rate by Medicaid /Medicare. Looks for long term improvements of encounter submission processes. Understands… more
    Humana (08/19/25)
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  • Clinical Program Manager- Payment Integrity…

    Molina Healthcare (Chandler, AZ)
    …goals and executes tasks and projects to ensure Centers for Medicare & Medicaid Services (CMS) and State regulatory requirements are met for Pre-pay Edits & ... oversight. + Collaborates with operational teams, enterprise stakeholders, and finance partners to proactively identify issues and implement resolution strategies.… more
    Molina Healthcare (08/14/25)
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  • Payment Integrity Program Manager - Health Plan

    Molina Healthcare (Tucson, AZ)
    …should be knowledgeable of and have experience with South Carolina Medicaid **Job Summary** Provides subject matter expertise and responsibility for oversight, ... goals and executes tasks and projects to ensure Centers for Medicare & Medicaid Services (CMS) and State regulatory requirements are met for Pre-pay Edits &… more
    Molina Healthcare (08/14/25)
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  • Lead Analyst, Payment Integrity

    Molina Healthcare (Mesa, AZ)
    …Assists and executes tasks and projects to ensure Centers for Medicare & Medicaid Services (CMS) and State regulatory requirements are met for Pre-pay Edits, ... oversight. + Collaborates with operational teams, enterprise stakeholders, and finance partners to proactively identify issues and implement resolution strategies.… more
    Molina Healthcare (08/14/25)
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  • Health Plan Operations, Payment Integrity Program…

    Molina Healthcare (Phoenix, AZ)
    …oversight. + Collaborate with operational teams, enterprise stakeholders, and finance partners to proactively identify issues and implement resolution strategies. ... requirements, workflows, and solutions that drive measurable improvement. + Partner with finance and compliance to develop business cases and support reporting that… more
    Molina Healthcare (08/14/25)
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  • Senior Encounter Data Management Professional

    Humana (Phoenix, AZ)
    …ensure successful submission and reconciliation of encounter submissions to Medicaid /Medicare. Ensures encounter submissions meet or exceed all compliance standards ... and develops tools to enhance the encounter acceptance rate by Medicaid /Medicare. Looking for long-term improvements of encounter submission processes. Begins to… more
    Humana (08/15/25)
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  • Manager Rebate Pharmacy Operations

    Prime Therapeutics (Phoenix, AZ)
    …management. Enforces teamwork across all internal departments, as well as with Medicaid Clients, and an in-depth understanding of all rebate programs, trends, and ... compliance with federal laws, state laws and standards of practice which govern the Medicaid Drug Rebate Program. + Ensures compliance with each State Medicaid more
    Prime Therapeutics (08/08/25)
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  • Reimbursement Consultant

    Intermountain Health (Phoenix, AZ)
    …reviewed, and reconciled. Reviews or prepares monthly Medicare and Medicaid contractual allowance calculations using technically acceptable and reasonably ... allowance and variance calculations. Works closely with the appropriate Budget Manager, Finance Director, and Chief Financial Officer to ensure that the computed… more
    Intermountain Health (08/13/25)
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