- Commonwealth Care Alliance (Boston, MA)
- …coding (CPT, HCPCS, Modifiers) along with the application of Medicare/Massachusetts Medicaid claims ' processing policies, coding principals and payment ... TPA Management and Claims Compliance, Healthcare Medical Claims Coding Sr. Analyst will be responsible...Medicaid + 7+ years progressive experience in medical claims adjudication, clinical coding reviews for claims ,… more
- NTT America, Inc. (Little Rock, AR)
- …* Analyze and document business, technical, and user requirements related to Medicaid Claims Adjudication and other functional areas. * Collaborate with ... organization, apply now. We are currently seeking a Senior Medicaid Business Analyst to join our team...implementation projects * Minimum of 6years of experience in Medicaid Claims Adjudication, including understanding of … more
- Commonwealth Care Alliance (Boston, MA)
- …Summary:** Reporting to the Director, Claims Operations and Quality Assurance, the Claims Sr. Analyst plays a critical role in ensuring accurate, compliant, ... resolution of complex reimbursement issues - including underpayments, overpayments, and disputes. The Claims Sr. Analyst serves as a subject matter expert on … more
- CareFirst (Baltimore, MD)
- **Resp & Qualifications** **PURPOSE:** The Senior Medicaid Encounters Risk Adjustment Analyst assumes a pro-active approach in ensuring the accuracy and ... coordination of analytical processes, investigation and interpretation of Maryland Medicaid risk score methodology, risk score calculation, submissions, enrollment,… more
- Insight Global (Raritan, NJ)
- …to the Senior Manager, and will oversee the critical operational aspects of Medicaid Payments. The Contractor will provide oversight on all issues relating to rebate ... timely basis and resolution of any disputes on rebate claims . Key Responsibilities: * Review and analyze data to...claim review, and commentary per identified metrics and the Medicaid Operational Guidelines. * Use various sources of data,… more
- Molina Healthcare (Iowa City, IA)
- …accurate and timely implementation and maintenance of critical information on all claims and provider databases, validate data housed on databases and ensure ... oversight to ensure that the contracts are configured correctly in QNXT. The claims are reviewed to ensure that the configured services are correct. Maintain the… more
- CTG (CA)
- …the build, configuration, testing, and support of Epic Professional Billing (PB) Claims functionality, with a focus on Behavioral Health and Ambulatory service ... + **System Configuration & Build:** Configure and maintain Epic PB Claims functionality, including claim edit rules, charge review workqueues, and payer-specific… more
- Montrose Memorial Hospital (Montrose, CO)
- …knowledge of hospital billing, collections and payment application for Medicare, Medicaid and Commercial insurances + Ability to effectively communicate, verbally, ... and non-verbally, in a clear, concise manner, both orally and in writing. What We Offer: + Mentoring + Continuing Education + 401 K Retirement Plan with employer match + Multiple health options to selection from + Ability to earn an additional $5.00 per hour… more
- Molina Healthcare (Dayton, OH)
- …Description** **Job Summary** Provides lead level support as a highly capable business analyst who serves as a key strategic partner in driving health plan financial ... and executing operational initiatives tied to Payment Integrity (PI) and provider claims accuracy. The individual will be relied upon to make independent, informed… more
- MyFlorida (Tallahassee, FL)
- …may inform policy development activities *Remain informed about the operations of the Medicaid fiscal agent, including Medicaid claims process, billing ... 68064828 - MEDICAL/HEALTH CARE PROGRAM ANALYST Date: Oct 2, 2025 The State Personnel...entity. The Agency is responsible for administering the Florida Medicaid program, the licensure and regulation of nearly 50,000… more