"Medicaid or claims jobs in Tallahassee, FL

On-Site Senior Database Analyst (Data analysis/visualization/manipulation/ SQL/SAS/Python/Power BI/Tableau/Medicaid managed care, long-term services and supports (LTSS)

Tallahassee, Florida

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15d ago

s and those authorized to work in the US are encouraged to apply. We are unable to sponsor H1b candidates at this time. NOTE: GIS will utilize the U.S. Department of Homeland Security's E-Verify system to verify the employment eligibility of all persons employed during the term of the Contract Note to Consulting Companies : ANY CONSULTANT S RESUME YOU SEND ME MUST BE ON YOUR COMPANY S PAYROLL, NO H1-VISA TRANSFER, NO PRO-MARKETING, NO SISTER COMPANY RESUMES. The resume should have the DIRECT con

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Contract, Third Party

Depends on Experience

Medicaid Claims QA Analyst(Healthcare)

Remote

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24d ago

Job Description: Job Title: Senior QA Tester Location: Remote Type: Full Time/W2 with Infinite Computer Solutions Job Description: Role summary: Responsible for claims testing for MMIS health care projects. Drive the test strategy and process, domain knowledge, perform analysis of business requirements, designs and develops test plans, ensures quality process, coordinates with customers on delivery and deployments. Works in team environment and provides testing guidance throughout the entire lif

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Full-time

$85,000 - $95,000

Senior SAS Business Analyst with Medicaid/Claims experience (Remote)

Remote

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9d ago

Job Title: Senior SAS Business Analyst with Medicaid/Claims experience Duration: 6 months 100% remote Citizenship requirement: live in the Continental US. DESCRIPTION and RESPONSIBILITIES SAS is seeking a full-time SAS Senior Business Analyst with strong Health Care domain experience to work with our Medicaid customers. The individual in this role will develop the Requirements Traceability Matrix, create technical documentation and assist with testing facilitation (QA and UAT) for healthca

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Third Party, Contract

$55 - $60

Senior QA Tester with Healthcare Medicaid Medicare Claims domain

Remote

•

Today

Hi Greetings from Infinite Computer Solutions ! Hope you are well today! I'd like to discuss a job opportunity with you. Hope you would be interested. Position: Senior QA Tester with Healthcare Medicaid Medicare Claims domain Location:Dallas, TX, St Louis, Mo, Las Vegas, NV, Hybrid/Remote Term : Fulltime About Infinite: InfiniteisagloballeaderindigitalengineeringandITservices,withover20yearsofexperiencedrivingdigitaltransformation.WepartnerwithleadingFortune1000companiestodeliverinnovative,sca

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Full-time

70,000+

Data Analyst with Medicaid/Gov Exp

Tallahassee, Florida

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30+d ago

Title:Data Analyst with Medicaid/Gov Exp - Primarily Remote Location:Tallahassee,FLLength:Long termRestriction:w2 or c2cDescription:Mode of Interview :- WebCam Interview Long term contract( initial PO for 1 year but usually goes for 4-5 years) Primarily remote( onsite as needed) Need 3 references with resume Primary Job Duties and Tasks:- Analyze Medicaid claims, eligibility, provider, and encounter data to identify trends, anomalies, and opportunities for improvement.Support program evaluation

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Contract

Depends on Experience

Medicaid QNXT Provider

Remote

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2d ago

Position:Medicaid QNXT ProviderLocation: Remote Job Summary:We are seeking an experienced Medicaid QNXT Provider Contract Setup & Testing Specialist with expertise in provider contract configuration, reimbursement methodologies, and functional testing within the healthcare payer domain. The ideal candidate will have hands-on experience setting up and validating provider contracts in the QNXT platform, testing contract configurations, validating fee schedules and reimbursement rates, and ensurin

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Third Party, Contract

Depends on Experience

Sr Manager over MMIS / Medicaid and PMB Data & Analytics

Remote

•

Yesterday

We are seeking to hire a Senior Manager for Medicaid / MMIS and PBM Data & Analytics, to join our teams working on a new multi-year awards we have within several State Govt clients, modernizing their Medicare/Medicaid systems. These roles are 100% remote. Being a US Cit is required for working on this program. This position pays a strong salary package with full benefits (including choice of healthcare plans, dental, vision, life insurance, 3 weeks PTO, 11 Paid Federal Holidays, and a matching

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Full-time

Depends on Experience

Senior QA Engineer Facets & Medicaid Regulatory Solutions

Remote

•

Today

Job Description: We are looking for a Senior QA Engineer with strong healthcare payer and Medicaid managed-care experience. Key Skills: TriZetto Facets testing Medicaid regulatory and state-specific requirements End-to-end integration testing Mainframe and Java application testing ETL testing (DataStage, Talend/TalendWorks) SQL, data validation, and reconciliation Claims, enrollment, eligibility, benefits, and payment testing

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Contract

Depends on Experience

Lead Data Analyst with Medicaid / Pharmacy / PBM experience

Remote

•

Yesterday

We are seeking to hire a Advisor (Lead) Data Analyst with expertise in Medicare / Pharmacy Benefits Management systems, to join our teams working on a new multi-year awards we have within several State Govt clients, modernizing their Medicare/Medicaid systems. These roles are 100% remote. Being a US Cit is required for working on this program. This position pays a strong salary package with full benefits (including choice of healthcare plans, dental, vision, life insurance, 3 weeks PTO, 11 Paid

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Full-time

Depends on Experience

RN Clinical Auditor - Behavioral Health

Remote

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24d ago

RN Clinical Auditor - Behavioral HealthLocation: Fully Remote, with occasional travel to Downtown Indianapolis, IN (expenses covered)Job Summary:We are seeking a Registered Nurse Clinical Auditor with extensive Behavioral Healthexperience to support medical record reviews and billing compliance audits for the Indiana Health Coverage Programs (IHCP). This role evaluates quality of care, reviews medical records and program policies, identifies compliance issues, prepares audit documentation and re

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Contract

Depends on Experience

Senior Facets Developer

Remote

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Yesterday

Job title: Senior Facets Developer Location: Remote Job type: Full time and Contract c2c both Interview: Video JD Candidates must have experience delivering healthcare payer solutions across a combination of TriZetto Facets, Mainframe, Java/J2EE, IBM DataStage, Talend/TalendWorks, databases, batch processing, APIs and system integrations. Candidates should have strong knowledge of Medicaid managed-care processes and state-specific regulatory requirements, together with a good understanding of Me

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Full-time

Depends on Experience

Sr ETL Data Analyst with QNXT / healthcare domain experience

Remote

•

Yesterday

We are seeking to hire a Senior ETL Data Analyst with QNXT / schema and healthcare domain knowledge, to join our teams working on a new multi-year awards we have within several State Govt clients, modernizing their Medicare/Medicaid systems. These roles are 100% remote. Being a US Cit is required for working on this program. This position pays a strong salary package with full benefits (including choice of healthcare plans, dental, vision, life insurance, 3 weeks PTO, 11 Paid Federal Holidays,

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Full-time

Depends on Experience

Healthcare Applications Developer (NCPDP/EDI/MMIS) - Fully Remote!!

Remote

•

Today

Role: Professional Developer (NCPDP F6 Implementation Project) Location: Remote USA Duration: 3+ months (possibility of extension) Key Responsibilities Lead and participate in the full software development lifecycle (SDLC) for the NCPDP F6 implementation, including analysis, design, coding, testing, deployment, and production support. Collaborate with business analysts, system architects, quality assurance teams, and technical stakeholders to translate functional requirements into scalable t

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Contract

45 - 50

Data Architect - Healthcare / No C2C

Remote

•

Today

Role: Senior Data Architect & SME Location: USA (Remote) Domain: Healthcare Data platforms, Medicaid/T-MSIS Domain expertise Duration: 4 months (possibility of extension) Role Summary Senior architecture role focused on modern healthcare data platforms, Medicaid/T-MSIS domain expertise, and large-scale modernization using AWS Databricks. Roles & Responsibilities Define scalable data architecture patterns using AWS Databricks, PySpark, Spark SQL, Delta Lake, and lakehouse / medallion architectur

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Contract

Depends on Experience

Business Analyst – Pharmacy Claims

Remote

•

Yesterday

What youll do Gather, analyze and translate pharmacy claims workflow requirements into Business Requirements Documents (BRDs), Functional System Specifications (FSDs) and user stories with clear acceptance criteria. Map transaction data fields across NCPDP Version F6 standards, including Eligibility Verification (E1), Claim Billing (B1), Claim Reversal (B2), Claim Rebill (B3) and Predetermination of Benefits (D1). Analyze field-level changes between NCPDP D.0 and F6, including: expanded field le

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Contract

Depends on Experience

California Workers Compensation Claims Examiner

Remote

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8d ago

Position: California Workers Compensation Claims Examiner Duration: 03 Months of contract with Possible extension or conversion Location: Remote Pay Range: $50/hr to $55/hr on W2 without benefits Required Skills: SIP is mandatory.3+ years of relevant and recent California Workers Compensation experience.Ed code experience preferred but not required.Indemnity claims experience. PRIMARY PURPOSE: To analyze complex or technically difficult workers' compensation claims to determine benefits due; t

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Contract

50 - 55

FACETS Architect (with Healthcare Claims)

Remote

•

Today

Remote Job Contract to Hire Important Notes from HM: Proficiency in innovating ideas and solutions resulting in tangible and measurable business outcomes. Mastery in creating architecture solutions within the enterprise architecture future state for technological acceleration of value outcomes, and effectively present and persuade key decision makers to invest in this acceleration. Must have recent solution/domain architecture experience with Facets G6 real-time and batch claims processing,

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Contract

$80 - $90

Medicaid DSH Consultant

Remote

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2d ago

Overview:Seeking an experienced Senior Medicaid Disproportionate Share Hospital (DSH) Consultant to support a state Medicaid program in the analysis, administration, and calculation of DSH supplemental payments.The consultant will provide subject matter expertise in Medicaid reimbursement methodologies, federal and state regulatory compliance, hospital data analysis, payment calculations, and audit support.The role involves working with healthcare providers and Medicaid stakeholders to ensure ac

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Contract

$80 - $90

Solution Architect – Facets & Medicaid Regulatory Transformation

Remote

•

Yesterday

We are seeking a senior Healthcare Solution Architect with strong TriZetto Facets architecture experience and expertise in Medicaid managed care and state-specific regulatory transformations. Key Responsibilities: Lead end-to-end architecture for Medicaid regulatory changes across healthcare payer platforms. Assess impacts across Facets, Mainframe, Java/J2EE, APIs, databases, batch systems, and ETL platforms. Design solutions for member enrollment, eligibility, benefits, claims adjudication, pri

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Contract

Depends on Experience

Data Systems Analyst (Medical Claims or Pharmacy claims)

Remote

•

Yesterday

Medical Claims or Pharmacy claims or membership information. SQL Server and SQL writing Some recent experience with Data modeling & Data Warehousing (Any platform is ok, does not have to be snowflake) EDI transaction experience API integration into Data Warehouse with EDI 834 and 837. This is not a BA role

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Contract

$50+

"Medicaid or claims jobs in Tallahassee, FL, USA