Healthcare Market Finance Lead Humana IncHealthcare Market Finance LeadMD$104,000–$143,000 / yearTo ensure Home or Hybrid Home/Office employees' ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees must meet the following criteria: At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is required; wireless, wired cable or DSL connection is suggested. The Market Finance Lead will also partner with actuarial, corporate finance, clinical, risk adjustment, market operations, provider engagement, hospitals, ancillary partners, sales/MarketPoint and value-based care providers.
Auditor (Healthcare Fraud) U.S. Department of JusticeAuditor (Healthcare Fraud)Washington, DC$111,338–$144,741 / yearCompletion of the requirements for a degree that included substantial coursework in Accounting or Auditing, e.g., 15 semester hours, but that does not fully satisfy the 24-semester-hour requirement of paragraph A, provided that (a) the applicant has successfully worked at the full-performance level in Accounting, Auditing, or a related field, e.g., Valuation Engineering or Financial Institution Examining; (b) a panel of at least two higher level professional Accountants or Auditors has determined that the applicant has demonstrated a good knowledge of accounting and of related and underlying fields that equals in breadth, depth, currency, and level of advancement that which is normally associated with successful completion of the 4-year course of study described in paragraph A; and (c) except for literal nonconformance to the requirement of 24 semester hours in Accounting, the applicants education, training, and experience fully meet the specified requirements. Typical work assignments will include: Conducting audits and investigations to identify violations of federal law (primarily the False Claims Act, 31 U.S.C. §§3729-3733, the Anti-Kickback Statute, 42 U.S.C. § 1320a-7b(b)(1)(A), and the Stark Law, 42 U.S.C. § 1395nn(a)) involving health care fraud against the Government; Analyzing Medicare and Medicaid claims data (as well as, on occasion, data involving other, similar government programs) and designing data techniques to detect fraud using CMS databases; Researching a variety of informational resources to query, gather and analyze patient-level data related to the provision of and reimbursement for health care services; Conducting investigations to make net worth determinations regarding the ability of individuals and organizations to pay settlements and judgments; and.
Sales Executive - Healthcare Alertus TechnologiesSales Executive - HealthcareBaltimore, MDA Day in the Life: Allocate a significant portion of your day engaging in salesforce activities, including qualifying leads, developing opportunities, scheduling demos, and closing deals. As the leader in mass notification, we are committed to providing customizable, scalable, and cost-effective solutions, as we know even a few seconds of warning can help save lives during an emergency.
16yrs Sr Project Manager-Continuous Improvement with healthcare GoIntellects16yrs Sr Project Manager-Continuous Improvement with healthcareWashingtonLead the management, implementation, and reporting of these large and complex initiatives by working through a team of program leaders to develop roadmaps, plans/timelines, and helping to determine staffing decisions based on current organizational capabilities and future needs ensuring cross-functional alignment and collaboration. The resource must have a proven track record of SDLC completion, excellent understanding and ability to implement project management methodologies, proven experience with vendor management and must be well-versed in district policies and procedures.
Revenue Cycle Manager - Medicare Value Based Care, Healthcare Financial Operations Amazon.com IncRevenue Cycle Manager - Medicare Value Based Care, Healthcare Financial OperationsArlington, VADive deep to identify root causes of claim and payment defects, distinguish symptoms from systemic issues, and prioritize the highest-value defects for resolution by partnering with clinical and revenue cycle teams to implement upstream fixes. We manage the full claims lifecycle-from charge capture and coding through denial management and payment posting-partnering with healthcare technology vendors to build automation, improve first-pass resolution rates, and scale efficiently.
Senior Designer - Social, Healthcare and Public Entities Tech McKinsey & Co IncSenior Designer - Social, Healthcare and Public Entities TechWashington DC, DCYou will create professional-quality deliverables that clearly communicate UX strategy, design rationale and research findings, including work plans, research protocols, personas, use cases, user flows, workflows, wireframes, prototypes, page maps, product specifications and other design documentation. You will partner closely with product managers, consultants, designers, developers and architects to create innovative digital solutions, drive decisions with data, track issues, estimate resource needs and schedules, and ensure design specifications are implemented effectively despite system complexity or constraints.
Information Technology - Architect, Solutions Pn Ampcus IncorporatedInformation Technology - Architect, Solutions PnBaltimore, MDRemote$90–$97 / hourHealthcare Payer and PBM Operations: Deep knowledge of and experience with health insurance and Pharmacy Benefit Management (PBM) business models, processes, capabilities, and supporting information systems, including pharmacy benefit design, formulary management, drug pricing, pharmacy networks, eligibility, claims, rebates, utilization management, specialty pharmacy, and member/provider services. Pharmacy Benefit Administration: Strong understanding of the end-to-end pharmacy benefit lifecycle, including benefit configuration, formulary and drug list management, prior authorization, step therapy, quantity limits, accumulator management, specialty drugs, pharmacy network administration, claims adjudication, reversals, coordination of benefits, and payment/reconciliation.
Director, Healthcare Services - M&A Alvarez & Marsal Holdings LLCDirector, Healthcare Services - M&AWashington, DC$165,000–$180,000 / yearDepending on the client project the responsibilities of a Director may include: Leading clients and internal teams through the full M&A lifecycle, including operational/synergy due diligence, carve-outs and integration planning and execution Working closely with other A&M teams working on deals, such as financial, HR and IT due diligence and integration teams, analytics teams, and offshore support teams. Technology Assessment: Whether for due diligence, self-assessment, or transformation objectives we support the review and analysis of platform, data and system architectures, and related applications / products, integrations, infrastructure, processes (PLC, SDLC, compliance), data (architecture, governance, BI, etc.), security, IT teams for scale, capability, cost, resilience, maintainability risk related issues and value opportunities.
16yrs Sr Project Manager-Continuous Improvement with healthcare GoIntellects Inc.16yrs Sr Project Manager-Continuous Improvement with healthcareWashington, DCFull timeLead the management, implementation, and reporting of these large and complex initiatives by working through a team of program leaders to develop roadmaps, plans/timelines, and helping to determine staffing decisions based on current organizational capabilities and future needs ensuring cross-functional alignment and collaboration. The resource must have a proven track record of SDLC completion, excellent understanding and ability to implement project management methodologies, proven experience with vendor management and must be well-versed in district policies and procedures.
Information Technology - Engineer, Systems Sr Ampcus IncorporatedInformation Technology - Engineer, Systems SrColumbia, MD$60–$64.46 / hourThe ideal candidate will have strong experience in infrastructure monitoring and a solid understanding of application performance monitoring concepts, without requiring deep code-level development expertise. This role will be responsible for monitoring infrastructure, systems, and applications to ensure high availability, performance, and reliability across the organization.
Federal Healthcare Programs Subject Matter Expert Sparksoft CorpFederal Healthcare Programs Subject Matter ExpertMDThe FHPSME will work collaboratively with the product manager, product owners, business owners, program management team and the data and reporting services teams to deliver business value in support of the Centers for Medicare & Medicaid Services (CMS) in detecting and preventing fraud, waste, and abuse within government-sponsored health programs. Analyse federal and industry data sources, including SSA, Treasury, State Medical Boards, Department of Justice, HRSA, Board Certification, and State Medical Boards, to support provider screening, sanctions, and fraud, waste, and abuse (FWA) detection activities.
Data Engineer - Healthcare and Life Sciences YO AI LabsData Engineer - Healthcare and Life SciencesWashington D.C., District of ColumbiaStrong experience with Databricks, DBT Core or Cloud, Python, Spark, SQL, distributed compute paradigms including in-memory, distributed, and MPP architectures, and Data Vault 2.0 including automate_dvDeep knowledge of AWS services including S3, Glue, Redshift, EMR, DynamoDB, Lambda, Athena, and Kinesis. Role Overview: The Technical Consultant role is responsible for end-to-end client management, program management, business growth, and client success by ensuring solutions are scalable, secure, cost-efficient, and aligned with modern data engineering, analytics, and AI/ML best practices.
Information Technology - Architect, Solutions Pn TalTeam, IncInformation Technology - Architect, Solutions PnBaltimore, MarylandFull timeUnderstand the healthcare payer business relationships among: Membership and enrollment, Premium billing, Claims processing, Provider payments, Member payments and refunds, Capitation, Risk adjustment, Government programs, Medicare, Medicaid, DSNP, Commercial business, Employer groups, Pharmacy benefits, Provider networks, Financial accounting, Regulatory reporting. Architect solutions involving capabilities such as: General Ledger, Accounts Payable, Accounts Receivable, Cash Management, Fixed Assets, Expenses, Tax, Subledger Accounting, Budgets, Refunds, 1099, Accounting Hub, OCI and Financial Reporting/Analytics.
Scrum Master / Servicenow Project Manager - Healthcare Platform (Remote) Greenberg-Larraby, Inc. (GLI)Scrum Master / Servicenow Project Manager - Healthcare Platform (Remote)Washington, DCRemoteThe Scrum Master / ServiceNow Project Manager for the Healthcare Platform will be responsible for managing the implementation and enhancement of ServiceNow solutions within the healthcare sector. Collaborate with cross-functional teams to ensure successful implementation of ServiceNow solutions tailored for healthcare environments.
Scrum Master / ServiceNow Project Manager - Healthcare Platform (Remote) Greenberg-Larraby, Inc. (GLI)Scrum Master / ServiceNow Project Manager - Healthcare Platform (Remote)Washington, DCRemoteThe Scrum Master / ServiceNow Project Manager for the Healthcare Platform will be responsible for managing the implementation and enhancement of ServiceNow solutions within the healthcare sector. Collaborate with cross-functional teams to ensure successful implementation of ServiceNow solutions tailored for healthcare environments.
Senior Solutions Engineer -Healthcare and Life Sciences Cloudera IncSenior Solutions Engineer -Healthcare and Life SciencesMDRemote$171,000–$205,000 / yearAs the pioneer in big data, Cloudera empowers businesses to apply AI and assert control over 100% of their data, in all forms, improving security, governance, and real-time and predictive insights. As a Senior Solutions Engineer you will: Own the technical sales process from introductory meetings (net new sales) through post-sales (customer satisfaction, upselling, and subscription renewals).
Senior Engagement Manager, Worldwide Public Sector Professional Services, Healthcare Life Sciences (HCLS) Amazon.com IncSenior Engagement Manager, Worldwide Public Sector Professional Services, Healthcare Life Sciences (HCLS)Arlington, VAApplying AWS frameworks like Well-Architected and Cloud Adoption Framework while demonstrating technical credibility across diverse stakeholders, you will distill customer needs into clear technical requirements, decompose complex problems, and make informed trade-off decisions considering performance, scalability, security, and business impact. In this role you will apply your management and leadership capabilities to successfully execute project plans, proactively identify and manage risks, resolve issues, escalate when appropriate, and drive projects to successful completion, while exceeding customer expectation.
Revenue Cycle Defect Analyst, Healthcare Finance Operations Amazon.com IncRevenue Cycle Defect Analyst, Healthcare Finance OperationsArlington, VAThrough data-driven analysis and manual review, you will identify patterns among aged receivables, analyze billing and cash receipts reports, and surface trends that contribute to revenue leakage, claim denials, and operational inefficiencies. The ideal candidate brings strong healthcare revenue cycle expertise, demonstrates exceptional analytical capabilities, possesses an eye for detail and process improvement, and has a proven ability to translate complex data into clear, evidence-based documentation.
Information and Technology - Assoc Systems Admin MindlanceInformation and Technology - Assoc Systems AdminBaltimore, MDEducation and Experience: " Previous experience that provides the knowledge, skills, and abilities to perform the job (comparable to 0 to 2 years ) or equivalent combination of education, training, & experience. " Years of experience refers to typical years of related experience needed to gain the required knowledge, skills, and abilities necessary to perform the essential functions of the job.
Information Technology Lead Halcyon Days ConsultingInformation Technology LeadMarylandHalcyon Days Consulting, LLC (HDC) is a veteran owned small business that specializes in the design and engineering of Tactical Mission Networks (TMN). The Information Technology Lead will serve as a strategic partner to executive leadership while maintaining hands-on oversight of day-to-day operations.