Medicaid Reviewer - Remote

Job title: Advanced Planning Writer · Location: NC DHHS, Raleigh NC · Duration: 12 Months from projected · Interview : Webcam Interview Only · The Division of Health Benefits is seeking an Advanced Planning Writer to create Advanced Planning Documents and develop Medicaid Detail ...

Advanced Planning Document Writer · Raleigh NC/REMOTE · 6+ months · Description: · The Division of Health Benefits, NC Medicaid, Advanced Planning Office is seeking an APD Writer with experience in developing Advanced Planning Documents (APDs). · This position develops Advanced P ...

Description · Role Overview · We are seeking an experienced Technology Solutions Management Consultant with deep expertise in Medicaid claims processing, encounter data, and related healthcare IT systems. The ideal candidate will bring strong knowledge of Medicaid regulations, ED ...

· The Utilization Review Medical Director is responsible for conducting clinical reviews of Durable Medical Equipment (DME) and related requests to support Integra's Utilization Management (UM) operations. This full-time, salaried role functions within a structured, high-volume ...

· AWS Data Architect/Engineer  · Company Overview   · Random Bit is a system modernization partner that specializes in enterprise architecture, solution architecture, data architecture, cloud transformation, data governance, compliance framework solutions, and organizational cha ...

This is an opportunity to apply DME experience in a new way by reviewing clinical documentation, assessing model-generated qualification outcomes, and identifying when decisions do or do not align with real-world payer standards. · ...

Company Description · Today, when you go to your doctor and get referred to a specialist (e.g., for sleep apnea), your doctor sends out a referral and tells you, "They'll be in touch soon." So you wait. And wait. Sometimes days, weeks, or even months. Why? Because too often speci ...

The Position: · The successful candidate will be a rockstar at identifying, analyzing, and resolving insurance company denials. While working with our Reimbursement, Commercial, and Finance teams this role will provide on-going insight and analytics on all medical insurance claim ...

· About Us: · The United States has the poorest maternal and birth outcomes of all developed countries with underserved, Black, Brown, Indigenous communities disproportionately affected. Cayaba Care is working to drastically improve the experience of affected communities by reim ...

· It's an exciting time to join the WellSense Health Plan, a growing regional health insurance company with a 25-year history of providing health insurance that works for our members, no matter their circumstances. · Job Summary: · The Prior Authorization Clinician is responsibl ...

The Director of Payer Strategy and Contracting will drive new business growth and ensure ongoing success in our strategic health plan partnerships. · ...

· Overview · BerryDunn is seeking a Senior Consultant to join our Medicaid Practice Group (MPG) that will have an initial focus supporting our client in Puerto Rico as a Medicaid Enterprise System (MES) Organizational Change Management (OCM) Subject Matter Expert (SME). As part ...

· Overview · Empower AI is AI for government. Empower AI gives federal agency leaders the tools to elevate the potential of their workforce with a direct path for meaningful transformation. Headquartered in Reston, Va., Empower AI leverages three decades of experience solving co ...

Description · Senior EDI Developer · Role Summary · We are seeking a Senior EDI Developer to serve as a lead technical contributor supporting multi-state Medicaid implementations within a healthcare EDI environment. This role requires deep expertise in EDIFECS and related technol ...

· Join AIR as a Research Associate with our Healthcare Transformation team. Our team works collaboratively to unravel the intertwined challenges of health care quality, costs, and access. Our team of experts – nurses, physicians, psychologists, economists, sociologists, data sci ...

· Our client is seeking a Senior Net Revenue Analyst who will play a crucial role in supporting management decisions through complex reimbursement data analysis. · This position offers the flexibility of a hybrid work environment while contributing to the financial integrity of ...

· What you'll do · In a few words… · Abarca is igniting a revolution in healthcare.  We built our company on the belief that with smarter technology we are redefining pharmacy benefits, but this is just the beginning… · As our Pricing Manager you will lead Abarca's end-to-end M ...

We're excited you're considering an opportunity with us. Responsible for working in collaboration with the Medical Director on driving the decrease in care variance, to ensure timely discharges, and to refer members to other plan resources to meet their care conditions. · ...

+Tomorrow Health is seeking an experienced Nurse Practitioner currently contracted with Michigan Medicaid to support virtual clinical care as part of a new and evolving care delivery initiative. This is a flexible, fully remote opportunity designed for a clinician who wants auton ...

The Enrollment Specialist will be the primary contact for the Enrollment Department for all Privia independent providers and responsible for all aspects of managing the payer enrollment process. · Primary Job Duties: · Enrolls providers new to Privia with all commercial health pl ...

The Insurance Verification Specialist completes eligibility and benefit verification to ensure timely submission of claims. The role involves daily verification using best practice processes, documenting benefits on patient accounts, preparing accounts for billing, reviewing clai ...