Medicaid jobs in Pennsylvania

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

Senior QA / Reconciliation Analyst with Healthcare payer / Medicaid / MMIS testing experience : Remote

Remote

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Today

Senior QA / Reconciliation Analyst Job Description Role Summary Senior QA and data-validation role focused on ETL testing, large-scale data reconciliation, regulatory-output validation, and root-cause analysis for AWS Databricks data pipelines. Roles & Responsibilities Define and execute test strategies for complex ETL / ELT pipelines and regulatory data outputs. Perform record-count, control-total, field-level, segment-level, and file-level reconciliation. Validate source-to-target mappings,

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Contract, Third Party

Depends on Experience

Solution Architect - Facets & Medicaid Regulatory Transformation

Remote

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Yesterday

Hi, Role:Solution Architect Facets & Medicaid Regulatory Transformation Location: Remote Broad architecture expertise across Mainframe + Java + Facets + DataStage/Talend, because they need to determine where each regulatory change belongs. Role Summary Seeking a senior healthcare Solution Architect to lead architecture and solution design for state-specific Medicaid regulatory changes across the health-plan technology ecosystem. The architect should have deep knowledge of Facets, Mainframe,

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Full-time, Third Party

Depends on Experience

Solution Architect – Facets & Medicaid Regulatory Transformation

Remote

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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

Sr Manager over MMIS / Medicaid and PMB Data & Analytics

Remote

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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

Only w2 - Senior Data Architect ( T-MSIS / Medicaid is Must) Remote

Remote

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Yesterday

Senior Data Architect & T-MSIS SME - Only w2 or 1099 Remote Long Term Contract 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 architecture principles. Design canonical/conformed data models, metadata-driven transformation patte

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Contract

55 - 62

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

Senior QA Engineer Facets & Medicaid Regulatory Solutions

Remote

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Yesterday

Job title: Senior QA Engineer Facets & Medicaid Regulatory Solutions Location: Remote Job type; Full time Interview: Video Candidates should have strong knowledge of Medicaid managed-care operations and experience working with state-specific Medicaid requirements. They should understand how regulatory changes affect member enrollment/eligibility, coverage, claim processing, authorization, pricing/payment, data and downstream health-plan operations. They should also possess a good working unders

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Full-time

Depends on Experience

Senior QA Tester with Healthcare Medicaid Medicare Claims domain

Remote

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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+

Senior QA Engineer Facets & Medicaid Regulatory Solutions

Remote

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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

Technical writer (8+ Yrs exp/MOU/MOA/Vendor Contracts/Medicaid APD/HIE/Health IT/Sharepoint): 10+ Mnths 100% Remote Project

Remote

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Yesterday

NCDIT 808154: This position ensures that the NC Health Information Exchange Authoritys process to execute MOUs, MOAs, vendor contracts and other agreements is well organized and efficient. They will work closely with NC HIEA business leads and partners to draft MOUs, MOAs, vendor contracts, and other agreements. NC HIEAs contracts writer will proactively coordinate with NCDITs legal, privacy and security, finance, and procurement teams to ensure that all required information is provided, issues

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Contract

48 - 52

EHR Integration Specialist

Remote

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Today

Title:EHR Integration Specialist Location:RemoteLength:Long termRestriction:w2 or c2cDescription:Interview Type: Webcam Interview Only Very long term project; initial PO for 1 year, expect to go for 4+ years Remote Job Description: Key ResponsibilitiesEHR Integration & Technical OnboardingLead rural provider onboarding to NC HealthConnex, guiding organizations and EHR vendors through connection requirements, HL7 v2 exchange, C-CDA/CCD exchange, and services such as NC*Notify.Conduct technical a

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Contract

Depends on Experience

Technical Business System Analyst (With Strong Medicaid and Provider Module)

Remote

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24d ago

Job Description: Job Title: Technical Business System Analyst Location: Remote Type: Full Time/W2 with Infinite Computer Solutions Job Description: Role Overview: The Technical Business Analyst will support the modernization of the CMdS Next Gen Provider Module, focusing on provider enrollment, validation, revalidation, and end-to-end provider lifecycle management. This role bridges business requirements and technical implementation, ensuring alignment between functional needs, system design, da

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Full-time

$70,000 - $90,000

Technical Writer

Remote

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Yesterday

Title:Technical Writer Location:RemoteLength:Long termRestriction:w2 or c2cDescription:Interview Type: Webcam Interview Only Very long term project; initial PO for 1 year, expect to go for 4+ yearsRemote Job Description: Key ResponsibilitiesWork closely with client business leads and partners to draft MOUs, MOAs, vendor contracts, and other agreementsProactively coordinate with client's legal, privacy and security, finance, and procurement teams to ensure that all required information is provid

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Contract

Depends on Experience

RN Clinical Auditor - Behavioral Health

Remote

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25d 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

MMIS Enterprise Architect

Remote

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Today

MMIS Enterprise Architect- Cloud & Compliance Location: Remote Long Term Key Responsibilities Strategic Architecture & Leadership o Lead the design and modernization of MMIS solutions, aligning with Medicaid regulations, CMS MITA guidelines, and enterprise architecture best practices o Develop and execute cloud migration strategies, leveraging AWS for scalability, reliability, and cost efficiency o Drive transformation initiatives, develop roadmaps, and deliver integrated strategies for modular

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Full-time, Part-time, Contract, Third Party

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

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 Facets / Java Developer Medicaid Regulatory Solutions

Remote

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Today

Role Summary An experienced Facets / Java Developer or Engineer to support implementation of state-specific Medicaid regulatory changes across Facets and surrounding healthcare applications. The engineer will work with regulatory, business, architecture, and QA teams to translate Medicaid requirements into system configuration, application changes, integrations, and data-processing solutions. The ideal candidate combines strong Facets claims and membership knowledge with hands-on Java engineerin

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Contract

Lead Data Analyst with Medicaid / Pharmacy / PBM experience

Remote

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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

Medicaid jobs in Pennsylvania, USA