• Medicare / Medicaid Claims Editing…

    Commonwealth Care Alliance (Boston, MA)
    …This role will ensure that the applicable edits are compliant with applicable Medicare and Massachusetts Medicaid regulations. The role will also be responsible ... research, as necessary on all new and revised coding logic, related Medicare / Medicaid policies for review/approval through the Payment Integrity governance… more
    Commonwealth Care Alliance (08/26/25)
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  • IT Business Systems Analyst Sr…

    Prime Therapeutics (Frankfort, KY)
    …It fuels our passion and drives every decision we make. **Job Posting Title** IT Business Systems Analyst Sr - Medicaid Pharmacy Implementations - Remote ... **Job Description** The IT Business Systems Analyst (BSA) Sr is responsible...Benefit Management (PBM) or healthcare experience with understanding of Medicare , Medicaid , the Exchanges along with regulatory… more
    Prime Therapeutics (08/27/25)
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  • Business Information Analyst Senior…

    Elevance Health (Grand Prairie, TX)
    ** Business Information Analyst Senior - Medicaid Encounters Data** The ** Business Information Analyst Senior** is responsible for analyzing and ... validating healthcare encounter data submissions to CMS (Centers for Medicare & Medicaid Services). This role involves ensuring the accuracy and completeness of… more
    Elevance Health (08/26/25)
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  • Medicaid Provider Hospital Reimbursement…

    Humana (Harrisburg, PA)
    …and help us put health first** The Medicaid (PPS) Provider Hospital Reimbursement Analyst also known as a Senior Business Intelligence Engineer will be an ... complex Medicaid provider reimbursement methodologies. The associate will support existing Medicaid business and expansion into new states. The business more
    Humana (08/14/25)
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  • Sr. Medicaid Regulatory Pricer…

    Zelis (Plano, TX)
    …and the personal interests that shape who you are. Position Overview The Sr. Medicaid Regulatory Pricer Analyst will collaborate with the Zelis Regulatory Pricer ... communicating rules, regulations, and procedures pertaining to public and private Medicaid payment systems. This position requires an in-depth knowledge of… more
    Zelis (08/27/25)
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  • Lead Business Analyst

    CGI Technologies and Solutions, Inc. (Fairfax, VA)
    **Lead Business Analyst ** **Category:** Business Analysis (functional and technical) **Main location:** United States, Virginia, Fairfax **Alternate ... . **Position Description:** CGI Federal is seeking a Lead Business Analyst to help lead the Department...Department of Health and Human Services (HHS), Centers for Medicare and Medicaid Services (CMS) Next Generation… more
    CGI Technologies and Solutions, Inc. (05/31/25)
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  • Sr Reimbursement Analyst

    CommonSpirit Health (Phoenix, AZ)
    …reimbursement services of Dignity Health. The position maintains current knowledge of Medicare Medicaid and other State and Federal regulations. The Sr. ... Managers and/or Directors. Accountabilities: Prepares interim and annual cost reports for Medicare Medicaid and other State or Federal agencies for Dignity… more
    CommonSpirit Health (07/29/25)
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  • HEDIS Analyst

    Medical Mutual of Ohio (OH)
    …lifecycle processes for all lines of business (Commercial, Marketplace, Medicare Advantage, and Medicaid ), including HEDIS audit submission, Consumer ... insured and self-funded group coverage, including stop loss, as well as Medicare Advantage, Medicare Supplement, and individual plans. **Supports corporate and… more
    Medical Mutual of Ohio (08/16/25)
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  • Lead Analyst , Payment Integrity

    Molina Healthcare (Sterling Heights, MI)
    …synthesize complex information. **PREFERRED QUALIFICATIONS:** + Experience with Medicare , Medicaid , and Marketplace lines of business . + Certified ... Summary** Provides lead level support as a highly capable business analyst who serves as a key...and executes tasks and projects to ensure Centers for Medicare & Medicaid Services (CMS) and State… more
    Molina Healthcare (08/20/25)
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  • Reimbursement Analyst

    Tidelands Health (Pawleys Island, SC)
    … will ensure timely and accurate reporting of all regulatory financial information to Medicare & Medicaid . This position requires the ability to manage strict ... is not limited to: IRS Form 990 Schedule H; Medicare , Medicaid & Tricare Cost Reports; ...years of progressive healthcare experience working as a Reimbursement Analyst in a hospital, a Medicare Administrative… more
    Tidelands Health (08/19/25)
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