• Medicare / Medicaid Claims…

    Commonwealth Care Alliance (Boston, MA)
    …and medical coding (CPT, HCPCS, Modifiers) along with the application of Medicare /Massachusetts Medicaid claims ' processing policies, coding principals and ... ensure that the applicable edits are compliant with applicable Medicare and Massachusetts Medicaid regulations. The role...Management + Collaborate system and data configuration into CES ( Claims Editing System) with BPaaS vendor and… more
    Commonwealth Care Alliance (08/26/25)
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  • Sr. Medicaid Regulatory Pricer Analyst

    Zelis (Plano, TX)
    …good understanding of public and private healthcare payment systems, medical claims , standard claim coding, claim editing , contracting, preferred-provider ... the personal interests that shape who you are. Position Overview The Sr. Medicaid Regulatory Pricer Analyst will collaborate with the Zelis Regulatory Pricer Product… more
    Zelis (08/27/25)
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  • Lead Analyst, Payment Integrity

    Molina Healthcare (Provo, UT)
    …Ownership** + Assists and executes tasks and projects to ensure Centers for Medicare & Medicaid Services (CMS) and State regulatory requirements are met ... a Managed Care Organization (MCO) or health plan setting, including experience in Medicaid and/or Medicare , or equivalent combination of relevant education and… more
    Molina Healthcare (09/07/25)
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  • Billing Representative

    Swedish Health Services (Seattle, WA)
    …reconciling claim runs, creating electronic claim files, and resolving errors. Resolve claims editing issues and interact with third party clearinghouse or ... editing and submission of accurate and timely insurance claims (electronic and manual) to third-party payers. Claims...role. + 2 years of hospital insurance billing, including Medicare and Medicaid and private insurance billing… more
    Swedish Health Services (09/09/25)
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  • QA Audit Manager - Operations

    Healthfirst (FL)
    …Services. + Knowledge of at least two or more lines of business such as Medicare NY/NJ, Medicaid , Family Health Plus, Child Health Plus, NH Family + Experience ... Experience in Healthcare/Health Plan customer service, operations, vendor management, or claims processing. + Previous work experience in an auditing function… more
    Healthfirst (08/16/25)
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