- Molina Healthcare (Fort Worth, TX)
- …** **Summary** Safeguard member trust and plan compliance by owning Molina's entire CMS Complaints Tracking Module (CTM) life cycle. As Director of CTM Oversight & ... issues, steer partners toward durable fixes, and convert disciplined CTM management into Stars gains, audit readiness, and measurable member-experience improvements.… more
- CVS Health (Austin, TX)
- …+ Ensuring that the relevant information is captured in Customer Relationship Management system (CRM) + Other duties as assigned. **Accountabilities** : ... an exciting opportunity available for highly motivated individuals as Medicare Sales Specialist. The position will be a part...and standards with a robust knowledge with respect to CMS and states regulations. + Ability to multitask, and… more
- Humana (Austin, TX)
- …radiology, and genetics.** + Knowledge of the managed care industry including Medicare Advantage and Managed Medicaid. + Utilization management experience in ... a medical management review organization, such as Medicare Advantage, managed Medicaid, or Commercial health insurance. + Experience with national guidelines… more
- Molina Healthcare (San Antonio, TX)
- …Summary** Responsible for leading, organizing and directing the activities of the Medicare Contracted Provider Post-Pay Claim Appeals and Disputes in accordance with ... the standards and requirements established by the Centers for Medicare and Medicaid. **Knowledge/Skills/Abilities** * Leads, organizes, and directs the activities of… more
- Humana (Austin, TX)
- …practice management + Utilization management experience in a medical management review organization, such as Medicare Advantage and managed Medicaid + ... by diverse resources which may include national clinical guidelines, CMS policies and determinations, Medicaid state contracts, clinical reference materials,… more
- Centene Corporation (Austin, TX)
- …planning and delivery of strategic programs and complex, large-scale enterprise-wide Medicare designs to execute defined requirements and meet company strategic ... executive level discussion. + End-to-end development, filing and execution of the Medicare Supplemental dental, vision and hearing benefits. Program Manager will own… more
- Molina Healthcare (TX)
- …average speed to answer, and average hold time are compliant with Centers for Medicare and Medicaid Services ( CMS ) regulations. + Ensures that adequate staffing ... for review. + Assures that activities and processes are compliant with CMS and National Committee of Quality Assurance (NCQA) guidelines and Molina policies… more
- Molina Healthcare (Fort Worth, TX)
- …with the Service Level Agreements between the parties. **Job Duties** + Develops Medicare and Medicaid vendor strategies aligned with CMS and State regulations, ... **Job Summary** This position is responsible for the holistic management of the external vendor relationships for Claims and Enrollment activities (along with other… more
- Molina Healthcare (San Antonio, TX)
- …building regulatory compliance audit procedures. * At the direction of management , coordinates and performs oversight audits and validation activities to ensure ... other evidence as part of regulatory audits. EX: DMHC, CMS active audits. Responsible for acting as the liaison...Provides draft written reports of audits and findings to management , including recommendations for any identified finding; Supports … more
- Guidehouse (Lewisville, TX)
- …from home._** **Essential Job Functions** + Account Review + Appeals & Denials + Medicare /Medicaid + Insurance Follow-up + Customer Service + Billing + UB-04 & ... CMS 1500 + Complete all business-related requests and correspondence...patients in all requested tasks. + Communicate to Guidehouse management areas of concern or areas of improvement. +… more