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QNXT Claims Examiner****Must be local to CA only

V.L.S. Systems, Inc

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Remote

Contract

Title: Claims Examiner Location: Remote (Candidate must reside in California no exceptions) Duration: 6+ month contract Position Summary: The Claims Examiner is responsible for providing comprehensive claims support by reviewing, analyzing, and researching complex healthcare claims. This role involves identifying discrepancies, verifying pricing, confirming prior authorizations, and ensuring accurate claims processing and payment. Required Experience and Qualifications: Minimum of 3 years exper
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Posted 5 days ago

QNXT Analyst

Prime Solutions, Inc.

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Remote

Third Party, Contract

The Senior QNXT Configuration Analyst is responsible for planning, designing, testing, and implementing configuration, business applications, including the Cognizant QNXT product suite. This role ensures system configurations align with business needs and regulatory requirements by collaborating with various departments and external vendor partners. Knowledge/Skills/Abilities: Strong understanding of healthcare IT systems, electronic health records (EHR), and health information exchanges (HIE).
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Posted 23 days ago | Updated 9 days ago

PBA Advisor Configuration Business Analyst - Pharmacy/QNXT

Gainwell Technologies LLC

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Kansas City, Missouri, USA

Full-time

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 As an PBA Advisor Configuration Business Analyst - Pharmacy/QNXT at Gainwell, you can contribute your skills as we harness the
Posted 60+ days ago | Updated 4 hours ago

PBA Senior Configuration Business Analyst - Pharmacy/QNXT

Gainwell Technologies LLC

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Kansas City, Missouri, USA

Full-time

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 As a PBA Senior Configuration Business Analyst - Pharmacy/QNXT at Gainwell, you can contribute your skills as we harness the po
Posted 60+ days ago | Updated 4 hours ago

Experienced QNXT Developer

Gainwell Technologies LLC

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Austin, Texas, USA

Full-time

Be part of a team that unleashes the power of leading-edge technologies to help improve the health and well-being of those most vulnerable in our country and communities. Working at Gainwell carries its rewards. You'll have an incredible opportunity to grow your career in a company that values work flexibility, learning, and career development. You'll add to your technical credentials and certifications while enjoying a generous, flexible vacation policy and educational assistance. We also have
Posted 60+ days ago | Updated 4 hours ago

Experienced QNXT Developer

Gainwell Technologies LLC

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Houston, Texas, USA

Full-time

Be part of a team that unleashes the power of leading-edge technologies to help improve the health and well-being of those most vulnerable in our country and communities. Working at Gainwell carries its rewards. You'll have an incredible opportunity to grow your career in a company that values work flexibility, learning, and career development. You'll add to your technical credentials and certifications while enjoying a generous, flexible vacation policy and educational assistance. We also have
Posted 60+ days ago | Updated 4 hours ago

Experienced QNXT Developer

Gainwell Technologies LLC

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Dallas, Texas, USA

Full-time

Be part of a team that unleashes the power of leading-edge technologies to help improve the health and well-being of those most vulnerable in our country and communities. Working at Gainwell carries its rewards. You'll have an incredible opportunity to grow your career in a company that values work flexibility, learning, and career development. You'll add to your technical credentials and certifications while enjoying a generous, flexible vacation policy and educational assistance. We also have
Posted 60+ days ago | Updated 4 hours ago

PBA Configuration Business Analyst - Pharmacy/QNXT

Gainwell Technologies LLC

•

Kansas City, Missouri, USA

Full-time

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 As a PBA Configuration Business Analyst - Pharmacy/QNXT at Gainwell, you can contribute your skills as we harness the power of
Posted 60+ days ago | Updated 4 hours ago

C2H Role || TriZetto QNXT Tester || Remote

Gtech LLC

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Remote or US

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

C2H Role and Fully Remote The tester will be responsible for testing custom code integration with QNXT and must have strong SQL skills. Requirements: At least 2 years of recent experience with TriZetto QNXT Experience testing at least two QNXT modules (e.g., claims, enrollments, eligibility, benefits, provider, billing, etc.) Strong understanding of QNXT data tables and data models Excellent SQL skills, including writing complex queries
Easy Apply
Posted 2 days ago | Updated 22 hours ago

QNXT Configuration Data Analyst****Must be local to CA only

V.L.S. Systems, Inc

•

Remote

Contract

QNXT Configuration Data Analyst || Remote Must have 5 years of experience as a QNXT Configuration Analyst. Must have a minimum QNXT version 5.9 Required Qualifications Serve as a subject matter expert for the following: QNXTNetworXOptum CES (Claims Editing System)Medi-Cal experienceTroubleshoot a wide range of business and system production issues by:Reviewing reported problemsConducting research using internal/external documentation (e.g., regulatory publications, user guides)Performing detaile
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Posted 5 days ago

QNXT Benefits Configuration SME -- REMOTE JOB

KPG 99 Inc.

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US

Third Party, Contract

Position : QNXT Commercial Benefits Configuration SME Location : Remote Job Duration: 6-12 Months Strong QNXT Benefit Configuration SME's on the Commercial side Technical QNXT Benefit Configuration, Commercial LOB Must Haves: Need to know QNXT benefits configuration (NOT JUST QNXT CLAIM NEEDS TO BE SPECIFC TO QNXT BENEFITS and know the ins and outs. will dive deep there in interviews.) Need to know commercial side (Ideal is 75% commercial; 25% Medicare) Knowledge of SQL. **writing SQL Querie
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Posted 60+ days ago | Updated moments ago

Facets Coding Analyst

Voto Consulting LLC

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Remote

Third Party, Contract

Position- Facets Coding Analyst Type- 100% remote, EST Visa- No H1 This is not a typical provider office medical coding role we re looking for someone with a managed care (payer) background who can work across teams to interpret benefit intent from plan documents and translate it into accurate codes (CPT, HCPCS, ICD, etc.) Required: Certified in one of the following: CPC, RHIT, or RHIARecent experience at a health planAt least 5 years of medical codingRecent experience with Facets Please make n
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Posted 3 days ago

Intake Agent/LTSS CMA - Remote

VIVA USA INC

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Remote

Contract

Title: Intake Agent/LTSS CMA - Remote Mandatory skills: Calls, Call Center, Microsoft Word, Excel, PC monitor, Profax, Dynamo, QNXT, Fax, EDI, medical services, medical review, medical management services, medical terminology, Medical, LTSS, URAQ, NCQA, case management, health care, care management, benefit plan, care plan, benefits verification, benefits and services, risk management, regulatory requirements, accreditation requirements, claim administrators, plan sponsors, member information,
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Posted 2 days ago

Senior Specialist, Provider Network Administration (Remote in UT)

Molina Healthcare

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Remote or Long Beach, California, USA

Full-time

Job Description JOB DESCRIPTION Job Summary Provider Network Administration is responsible for the accurate and timely validation and maintenance of critical provider information on all claims and provider databases. Staff ensure adherence to business and system requirements of internal customers as it pertains to other provider network management areas, such as provider contracts. KNOWLEDGE/SKILLS/ABILITIES Generates and prepares provider-related data and reports in support of Network Mana
Posted 12 days ago | Updated 8 hours ago

Advisor Business Analyst - Medicaid

Gainwell Technologies LLC

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Plano, Texas, USA

Full-time

Be part of a team that unleashes the power of leading-edge technologies to help improve the health and well-being of those most vulnerable in our country and communities. Working at Gainwell carries its rewards. You'll have an incredible opportunity to grow your career in a company that values work flexibility, learning, and career development. You'll add to your technical credentials and certifications while enjoying a generous, flexible vacation policy and educational assistance. We also have
Posted 9 days ago | Updated 4 hours ago

Principal Business Analyst - Medicaid

Gainwell Technologies LLC

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Plano, Texas, USA

Full-time

Be part of a team that unleashes the power of leading-edge technologies to help improve the health and well-being of those most vulnerable in our country and communities. Working at Gainwell carries its rewards. You'll have an incredible opportunity to grow your career in a company that values work flexibility, learning, and career development. You'll add to your technical credentials and certifications while enjoying a generous, flexible vacation policy and educational assistance. We also have
Posted 9 days ago | Updated 4 hours ago

Claims Systems Program Manager

Kern Health Systems

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Bakersfield, California, USA

Full-time

KHS reasonably expects to pay starting compensation for the position of Claims System Process Improvement Program Manager in the range of $83,625 -106,622 Annual On-site Position About us Kern Health Systems is dedicated to improving the health status of our members through an integrated managed health care delivery system. About the role Under management direction, responsible for supervising the testing, configuration and auto adjudication activities in the Claims Department to ensure accuracy
Posted 52 days ago | Updated moments ago

IS Application Systems Administrator II

CareOregon, Inc.

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Milwaukee, Wisconsin, USA

Full-time

Pay & Benefits Estimated hiring range $90,225 - $110,275 / year, 5% bonus target, full benefits. ;br> Candidates hired for remote positions must reside in Oregon, Washington, Utah, Idaho, Arizona, Nevada, Texas, Montana, or Wisconsin. Job Title IS Application Systems Administrator II Exemption Status Exempt Management Level n/a Direct Reports n/a Manager Title IS Application Support Manager Department Business Intelligence Requisition 25000 Pay & Benefits Estimated hiring range
Posted 27 days ago | Updated 4 hours ago

IS Application Systems Administrator II

CareOregon, Inc.

•

Austin, Texas, USA

Full-time

Pay & Benefits Estimated hiring range $90,225 - $110,275 / year, 5% bonus target, full benefits. ;br> Candidates hired for remote positions must reside in Oregon, Washington, Utah, Idaho, Arizona, Nevada, Texas, Montana, or Wisconsin. Job Title IS Application Systems Administrator II Exemption Status Exempt Management Level n/a Direct Reports n/a Manager Title IS Application Support Manager Department Business Intelligence Requisition 25000 Pay & Benefits Estimated hiring range
Posted 27 days ago | Updated 4 hours ago

IS Application Systems Administrator II

CareOregon, Inc.

•

Bozeman, Montana, USA

Full-time

Pay & Benefits Estimated hiring range $90,225 - $110,275 / year, 5% bonus target, full benefits. ;br> Candidates hired for remote positions must reside in Oregon, Washington, Utah, Idaho, Arizona, Nevada, Texas, Montana, or Wisconsin. Job Title IS Application Systems Administrator II Exemption Status Exempt Management Level n/a Direct Reports n/a Manager Title IS Application Support Manager Department Business Intelligence Requisition 25000 Pay & Benefits Estimated hiring range
Posted 27 days ago | Updated 4 hours ago