- State of Colorado (CO)
- …INTEGRATION BUSINESS ANALYST: + Department's Staff Authority for Colorado Medicaid Enterprise System (CMES) system and interface design, data integration, API ... CMES integration and eligibility systems, MITA 3.0 standards, and federal CMS guidance to design and validate technical solutions that operationalize policy… more
- Hartford HealthCare (Manchester, CT)
- …accurate information to payers. The role integrates and coordinates utilization management and denial prevention by focusing on identifying and removing unnecessary ... for preoperative, concurrent, and retrospective reviews in accordance with the utilization management plan. The UM CM ensures the appropriate status and level of… more
- Blue Cross and Blue Shield of Minnesota (Eagan, MN)
- …focused on ACA, Medicaid, and/or Medicare Advantage is essential. Knowledge of CMS ACA EDGE, Medicare Advantage response files (MAOs), and/or Minnesota Medicaid ... highly valued. Proficiency with healthcare file formats, understanding of CMS guidelines, and excellent problem-solving abilities are important. Strong communication… more
- MyFlorida (Tallahassee, FL)
- …coordinating the ongoing development and support activities of the Health Clinic Management System , Immunization registry, and children's medical services data ... - 64001456 Date: Dec 22, 2025 The State Personnel System is an E-Verify employer. For more information click...works with central office, county public health department and CMS clinic management staff. + This position… more
- Blue Cross and Blue Shield of Minnesota (Eagan, MN)
- …with SQL, Power BI, and Medicare Advantageencounterdata submissions. Familiarity with CMS ACA EDGE, Minnesota Medicaid rejection reports, healthcare file formats, ... and CMS guidelines is highly valued. Strong problem-solving, communication, and...* Serves as senior subject matter expert associated with content , processes, and procedures. * May lead project teamsand… more
- Oracle (Salem, OR)
- …applications and dashboards that run in our clients EHR (Electronic Health Record) system to enable our clients' to track compliance with the requirements of the ... Centers for Medicare & Medicaid Services ( CMS ) and The Joint Commission (TJC). The compliance rate...you to work closely with multi-functional teams, including product management , submissions operations teams, and other software development teams… more
- Highmark Health (Cheyenne, WY)
- …clinical terminology and anatomy/physiology, Centers for Medicare and Medicaid Services ( CMS ) coding guidelines, and Risk Adjustment Data Validation (RADV) Audits. ... Patient Monitoring (RPM) risk adjustment projects to comply with all CMS requirements by analyzing physician documentation and interpreting into ICD10 diagnoses… more
- TEKsystems (Rockford, IL)
- …review and resolve medical claims. Your day‑to‑day responsibilities will include: Data & Case Management + Work within CMS portals to process incoming cases and ... systems like Microsoft Office, EMR tools, Salesforce CRM, and CMS databases to retrieve or input information Who You...Office (Excel, Outlook) + Medical terminology (a plus!) + CMS platforms + Salesforce CRM + EMR systems Job… more
- Compass Group, North America (Alexandria, KY)
- …compliance with multiple overlapping authorities including local and state health departments, CMS , The Joint Commission, and OSHA. The ideal candidate will bring ... proven healthcare leadership or management experience, deep knowledge of regulatory and sanitation standards,...walk-throughs to ensure full compliance with Department of Health, CMS , and Compass Group standards. + Direct and oversee… more
- General Dynamics Information Technology (Fairfax, VA)
- …as the base application of HIGLAS provides CMS with a uniform financial management system to account for over $1 Trillion in outlays for healthcare each ... Medicaid Services ( CMS ) program. HIGLAS is a very large, complex system with approximately 3,000 total users, processing an average of 4.5 million transactional… more