Medicare jobs in woodlawn, md

Remote or Hybrid

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Today

Remote position Must have Medicare exp & Mobile testing Must Have: 5+ years of Medicare experience 10 + years of experience in technology Quality Engineering. Strong experience with UI and Mobile OS (iOS/Android) testing Proficiency in API testing tools such as Postman, Bruno, or REST Assured. Experience of SDLC processes, agile methodology and QE practices. Agile certification is preferred. Experience with using AWS services like S3, Lambda, DynamoDb etc. Strong experience with UI and database

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Third Party

Enterprise Data Modeler Medicare Advantage

Remote

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5d ago

We are looking for a Senior Enterprise Data Modeler with deep healthcare domain expertise to lead the development of enterprise and domain data models for a strategic data transformation program. You will bridge the gap between business stakeholders and technical execution teams to build resilient, enterprise-wide data structures. Key ResponsibilitiesDesign and maintain Enterprise, Logical, Physical, and Canonical Data Models. Translate complex business concepts into robust domain data models. P

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Contract

Depends on Experience

Clinical Pharmacist Advisor - Medicare - Remote

Remote

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24d ago

Title: Clinical Pharmacist Advisor - Medicare - Remote Mandatory skills: managed care, PBM environment, institutional healthcare, pharmacy, Case Review, Processing, incoming coverage-related requests, Accurately set up cases, review documentation, apply work instructions, business, medical correspondence, technical procedures, Medicare regulations, Outreach, Information Gathering, Conduct outbound calls, positive business image, Documentation, Accuracy, Compliance Standards, CMS-mandated timelin

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Contract

47 - 52

Fraud, Waste, and Abuse (FWA) Medical Record Reviewer

Hybrid in Elkridge, Maryland

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7d ago

Fraud, Waste, and Abuse (FWA) Medical Record ReviewerElite Technical is seeking a Fraud, Waste, and Abuse (FWA) Medical Record Reviewer! We are seeking an experienced healthcare fraud investigator and medical record reviewer with expertise in analyzing medical documentation, claims data, provider billing patterns, and regulatory compliance requirements. Skilled in identifying potential fraud, waste, and abuse indicators through detailed record review, coding validation, and investigative researc

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Contract

40 - 50

Data Modeler with Medicare Advantage

Remote

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12d ago

Enterprise Data Modeler (Medicare Advantage) Position Summary We are seeking a highly experiencedEnterprise Data Modelerto lead the development of enterprise and domain data models that will serve as the foundation of a strategic enterprise data transformation program. This role will be responsible for creating and maintaining: Enterprise Business Data ModelsCanonical Data ModelsLogical Data ModelsPhysical Data ModelsDomain Data Models across prioritized business domainsCritical Success Factors

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Contract

Depends on Experience

Healthcare Informatics Analyst (Pharmacy OR Medicare Advantage - Fully Remote Contract Role )

Remote

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24d ago

Position 2: Sr. Healthcare Informatics Analyst (Medicare Advantage)Seeking a Senior Healthcare Informatics Analyst! The selected candidate will independently provide analytics in understanding and improving how health care is valued, utilized and provided. This position will develop analytic attributes that pertain to patient level health utilization/outcome, provider performance measures, risk-adjusted revenue optimization, medical cost management, and behavior attributes on patient/provider en

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Contract

75 - 80

Medicare Benefits Advisor

Remote

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14d ago

Immediate need for a talented Medicare Benefits Advisor. This is a 03 - 04+months contract opportunity with long-term potential and is located in Denver, CO (Remote). Please review the job description below and contact me ASAP if you are interested. Job ID: 26-22375 Pay Range: $37/hr - $40/hour. Employee benefits include, but are not limited to, health insurance (medical, dental, vision), 401(k) plan, and paid sick leave (depending on work location). Key Responsibilities: Work Schedule & HoursPa

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Contract

$37 - $40

Functional Business Analyst with SNAP, TANF, QHP, Medicaid/Medicare programs exp - 100% Remote - W2

Remote

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11d ago

WHO WE ARE: Founded in 2007, DTI (Diversified Technology, Inc.) is a successful African American owned IT Consulting/Staffing firm based in Chicago''s Loop. WHAT WE DO: We focus on providing delivery, staffing, and supported services such as enterprise integration/implementations including, but not limited to, CRM, EAM, ERP, PMO, and QA. We service clients in SLED (state/local gov''t & education), financial services, fortune, public utility, as well as regularly partnering with Big 4 SI partner

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Contract

40 - 40

Senior Provider Field Representative - Washington, DC ONSITE

Baltimore, Maryland

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Today

Great companies need great teams to propel their operations. Join the group that solves business challenges and enhances the way we work and grow. Working at Gainwell carries its rewards. You'll have an incredible opportunity to grow your career in a company that values your contributions and puts a premium on work flexibility, learning, and career development. Summary The Provider Field Representative, supports the provider community in a variety of areas including but not limited to virtual an

Full-time

USD 51,700.00 - 73,800.00 per year

Sr Health Data Analyst - Compliance & Privacy

Maryland

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Today

Excel. Empower. Advance. Shine. Belong. Explore. Flourish. Champion. Make It Happen At Hopkins! Johns Hopkins Health Plans (JHHP) is the managed care and health services business of Johns Hopkins Medicine, one of the premier health delivery, academic, and research institutions in the United States. JHHP is a $2.5B business serving over 400,000 lives with lines of business in Medicaid, Medicare, commercial, military health, health solutions, and venture investments. JHHP has become a leader in pr

Full-time

USD 41.00 per hour

Data Management & Governance Lead

Woodlawn, Maryland

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Today

Job#: 3038996 Job Description: Title: Data Management & Governance Lead Location: Remote EST - local candidate to Washington DC available for on-site meetings would be highly preferred Duration: 6 Months+ w/ conversion to customer FTE if awarded the project/work (5+ year award) Clearance Eligibility Requirement: Must be eligible to attain Public Trust for CMS prior to starting Start Date: 3-5 weeks from offer pending Public Trust The Data Management & Governance Lead role will be supporting

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Full-time

$46 - $56 per hour

VP, Chief of Solution Strategy, Deputy CIO

Columbia, Maryland

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Today

Job Type Full-time Description About Us eSimplicity is a modern digital services company that partners with government agencies to improve the lives and protect the well-being of all Americans, from veterans and service members to children, families, and seniors. Our engineers, designers, and strategists cut through complexity to create intuitive products and services that equip federal agencies with solutions to courageously transform today for a better tomorrow. Purpose and Scope eSimplic

Full-time

USD 190,000.00 - 280,000.00 per year

Product Owner – Capitation & Value-Based Care

Remote

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21d ago

Job Title: Product Owner Capitation & Value-Based Care Location: Remote/Hybrid Experience: 712 Years Position Summary We are looking for a Product Owner with deep experience in Capitation, Value-Based Care (VBC), and Provider Reimbursement. This role will own products supporting capitation payments, provider incentives, attribution, quality programs, and population health analytics while partnering with payer and provider stakeholders. Capitation is a payment model where providers receive a fix

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Contract

Depends on Experience

HRSN Medicaid Claims Analyst With QNXT

Remote

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6d ago

Position- HRSN Medicaid Claims Analyst Type- 100% Remote (PST Hours) Visa- No H1 What you'll do: Review and resolve HRSN claims assigned through QNXT work queues including rent, rental arrears, utility assistance, storage, and housing support claims. You'll analyze pended, denied, and audit-flagged claims, correct claim data, resolve QNXT edits, review potential duplicate submissions, and move valid claims through adjudication and payment. Much of the initial work focuses on reducing the existin

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Third Party, Contract

Depends on Experience

Software Engineer (Data & AI)

Maryland

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Today

Job#: 3043201 Job Description: Software Engineer (Data & AI) Location: Home, Maryland (Remote) Role Overview We are seeking a motivated, forward-thinking Software Engineer to support the Fraud and Prevention Services (FPS) program. This role involves contributing to new initiatives, adapting to evolving requirements, and learning emerging tools and technologies. The position is a key member of a high-performing technical team focused on enhancing the value delivered to clients. Key Responsi

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Full-time

$30 - $40 per hour

Claims Examiner - Workers Compensation - W2 Only

Remote

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5d ago

Position: Claims Examiner - Workers Compensation - W2 Only Duration: 03 Months of Contract with possible extension or conversion Pay Range: $52/hr to $56/hr on W2 (without Benefits) Requirements: Only Ex-Sedgwick candidatesAny specific skill/ certification/ license: CA adjuster certificationYears of experience: 3+ years of relevant experience Primary purpose: To analyze complex or technically difficult workers'' compensation claims to determine benefits due; to work with high exposure claims

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Contract

52 - 56

Technical Project/Delivery Manager With Medicaid Experience - Remote

Remote

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3d ago

Required:15+ years of overall IT experience5+ years of managerial experienceDeep functional knowledge of Healthcare processes specially Medicaid BusinessAware of the Cloud native architecture along with understanding of associated technologiesDemonstrated understanding of Project Management processes, strategies and methodsExperience mentoring, coaching and developing rising talent in the technology departmentExcellent time management and organizational skills and experience establishing guideli

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Contract, Third Party

$61

Epic Tapestry Contracts Administration SME

Remote

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19d ago

** This is 5 months contract with possibility of extension. Work Arrangement: 100% Remote Schedule: Full-time, 40 hours per week Working Hours: Eastern Time business hours Industry: Healthcare Insurance / Health Plan Position SummaryWe are seeking an experienced Epic Tapestry Contracts Administration Subject Matter Expert to lead contract-related application build and provide structured knowledge transfer within a healthcare insurance environment. This is a hands-on SME-level position requiring

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Contract, Third Party

Depends on Experience

Business Analyst III

Remote

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5d ago

Immediate need for a talented Business Analyst . This is a 10+ months contract opportunity with long-term potential and is located in U.S(Remote). Please review the job description below and contact me ASAP if you are interested. Job ID:26-25605 Pay Range: $35/hr - $40/hour. Employee benefits include, but are not limited to, health insurance (medical, dental, vision), 401(k) plan, and paid sick leave (depending on work location). Key Responsibilities: Schedule: MondayFriday, 8:00 AM5:00 PM EST o

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Contract

35 - 40

Applied Behavior Analysis / ABA (Utilization Management)

Remote

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Today

Active BCBA (Board Certified Behavior Analyst) certification and state licensure (3+ years of ABA (Applied Behavior Analysis) clinical experience - Required Experience creating and supervising ABA (Applied Behavior Analysis) treatment plans Direct patient care background (dealing with children with Behavior / Autism issues) Utilization Management or insurance review experience strongly preferred Comfortable reviewing medical necessity and authorization requests Familiar with managed care and pay

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Contract

Depends on Experience

Medicare jobs in Woodlawn, MD, USA