- Commonwealth Care Alliance (Boston, MA)
- …Reporting to the Director, Claims Operations and Quality Assurance, the Claims Sr . Analyst plays a critical role in ensuring accurate, compliant, and timely ... reimbursements within the scope of MassHealth and Medicare Advantage programs. Under the direction of the Director...issues - including underpayments, overpayments, and disputes. The Claims Sr . Analyst serves as a subject matter expert on… more
- CVS Health (Hartford, CT)
- …pre-certification, and predetermination of covered benefits in the commercial, Medicare , and Medicaid environment. This Wheelchair DME consultant provides subject ... and correct application of Aetna policies and practices for commercial, Medicare , and Medicaid environments. ◾Proactively use data analysis to identify opportunities… more
- Molina Healthcare (UT)
- **Job Description** **Job Summary** The Sr Specialist , Member & Community Interventions oversees and implements new and existing clinical quality member ... intervention initiatives including all lines of business ( Medicare , Marketplace, Medicaid). Executes health plan's member and community...time zone. **Job Duties** + Acts as a lead specialist to provide project, program , and/or initiative… more
- City and County of San Francisco (San Francisco, CA)
- …2232's may include, but are not limited to: + Disease Prevention and Control Senior Specialist /Medical Director + Provides clinical oversight of a unit or clinic ... COVID, influenza, measles, Salmonella, HIV, STIs, Tuberculosis or emerging diseases. + Senior Specialist in Forensic Pathology + Performs medicolegal autopsies… more
- Staffing Solutions Organization (Albany, NY)
- …a diverse workforce, which is a reflection of our clients and the people they serve. ** Senior Healthcare Program Specialist (Level 2 or 3) - Albany, NY** ... support to the other bureaus within the group, if needed. **Basic Qualifications:** + Senior Healthcare Program Specialist - Bachelor's Degree, + 8 years… more
- Staffing Solutions Organization (Albany, NY)
- …a diverse workforce, which is a reflection of our clients and the people they serve. ** Senior Healthcare Program Specialist (Level 2 or 3) in Albany, NY** ... will be 100% In-Office and will move to a 50% Remote Schedule.** **Duties:** The Senior Healthcare Program Specialist (level 2 or 3) will be located… more
- Medical Mutual of Ohio (Brooklyn, OH)
- …fully insured and self-funded group coverage, including stop loss, as well as Medicare Advantage, Medicare Supplement, and individual plans. Builds and sustains ... to reconcile discrepancies and identify issues, proposes solutions, and escalates issues to senior leadership as needed. . Prepares and leads weekly, monthly, and ad… more
- Access: Supports For Living (Middletown, NY)
- Senior Billing Specialist Location: Middletown, NY, United StatesDate Posted: Jul 31, 2025 Share: share to e-mail Apply Now Save JobSaved Description Location: ... (40hrs) Job Description: Reporting to the A/R Manager, the Senior Billing Specialist is a key position...of weekly claims processing + Analyze, billing and processing program claims for accuracy and completeness; submit claims to… more
- Prime Healthcare (Ontario, CA)
- …preparation of various government reports and support their audits. The Corporate Senior Government Reimbursement Specialist is responsible for preparing and ... understanding the complexity of a cost report. The Corporate Senior Government Reimbursement Specialist fully understands how one section of the report is linked… more
- Staffing Solutions Organization (Albany, NY)
- …a diverse workforce, which is a reflection of our clients and the people they serve. ** Senior Healthcare Program Specialist (Level 2 or 3) in Albany, NY** ... quality assurance of the NYSOH Marketplace performance relating to program eligibility determinations, enrollment functionality and notice generation. This person… more