- CareFirst (Baltimore, MD)
- **Resp & Qualifications** **PURPOSE:** The Senior Medicaid Encounters Risk Adjustment Analyst assumes a pro-active approach in ensuring the accuracy and ... business process and technical workflow documents. + Understand Medicaid risk score methodology, including risk score calculation, financial risk receivable… more
- Fairview Health Services (Minneapolis, MN)
- …oversee the management of third-party external reviews for Medicare and Medicaid lines of business . **Additional Responsibilities** + Demonstrates proficiency ... **Job Overview** Establish and maintain patient access to Fairview Pharmacy services across the system (26 Retail pharmacy sites; 11 Acute Care pharmacy … more
- AmeriHealth Caritas (Charleston, SC)
- …policy and operational procedures to effectively provide technical expertise and business rules. + Participate in encounter rejection reconciliation activities. + ... 1 to 2 years managed care or related experience preferred. + 1 to 2 years Medicaid experience preferred. + 2 to 5 years of claims analysis experience in a healthcare… more
- Queen's Health System (Honolulu, HI)
- …B. EXPERIENCE: * In addition to the educational requirement, three (3) years pharmacy operations, business operations or finance experience, preferably in a ... monitoring and routine auditing of virtual inventory accumulation, purchasing procedures, Medicaid billing procedures, patient eligibility, new areas of service, and… more
- Humana (Louisville, KY)
- …caring community and help us put health first** The Vice President, Medicaid Clinical Economics & Quality provides strategic and operational leadership for clinical ... effectiveness within the Medicaid segment. This function integrates Medical Economics, Clinical Insights, and Quality to deliver improved health outcomes, optimized… more
- Elevance Health (Louisville, KY)
- …of new technologies and a strong, clinical-first lens, to deliver member-centered, lasting pharmacy care. The ** Business Analyst II** will support Clinical ... **Formulary Business Analyst II - CarelonRx** **Location:**...Experience with Excel skills strongly desired. + _PBM or pharmacy experience (eg pharmacy technician, Formulary Product… more
- CareFirst (Baltimore, MD)
- **Resp & Qualifications** **PURPOSE:** The Senior Risk Adjustment Business Operations Analyst assumes a pro-active approach in ensuring the accuracy and ... operational requirements for Medicare Advantage(MA), Affordable Care Act (ACA) & Medicaid Lines of Business (LOB). Additional responsibilities include… more
- Prime Therapeutics (Jefferson City, MO)
- …those we serve. Looking for a purpose-driven career? Come build the future of pharmacy with us. **Job Posting Title** Compliance Analyst Principal - Remote **Job ... Supports new client implementations + Supports all lines of business (commercial/HIM, Medicare and Medicaid ) + Other...legal or compliance related roles for a healthcare or Pharmacy Benefit Management organization, or within a highly regulated… more
- Prime Therapeutics (Topeka, KS)
- …for those we serve. Looking for a purpose-driven career? Come build the future of pharmacy with us. **Job Posting Title** Regulatory Analyst Sr - Remote **Job ... Description** The Senior Regulatory Analyst is responsible for leading portions of departmental regulatory review and analysis, external audits and accreditation… more
- Mount Sinai Health System (New York, NY)
- … Analyst has responsibilities that include: analyzing medical and pharmacy trends, researching all facility amendments, procuring all financial data necessary ... of patients. We are accelerating a transition to a business model focused on population health management - our...to Facility Contracts for all Commercial, Medicare Advantage and Medicaid Managed Care Plans. The team serves as MSHP's… more