- Kelsey-Seybold Clinic (TX)
- …Knowledge of health Care and insurance and the ability to Interpret/Apply Medicare Prescription Drug Benefits, Medical Benefit Interpretation, CMS Regulations, ... Member Service Representatives II-KSPA handles member and provider calls for our Medicare Advantage plan and have demonstrated ability to interpret Medicare … more
- Humana (Austin, TX)
- … management . + Utilization management experience in a medical management review organization, such as Medicare Advantage, managed Medicaid, or Commercial ... by other healthcare professionals are in agreement with national guidelines, CMS requirements, Humana policies, clinical standards, and (in some cases) contracts.… more
- Centene Corporation (Austin, TX)
- …fresh perspective on workplace flexibility. **Position Purpose:** Promote increased Medicare Supplemental Benefit efficiency, service levels, and value by capturing, ... Develop, plan, lead, monitor, and own multiple, concurrent resultant Medicare Supplemental Benefits utilizing cross functional teams to deliver defined… more
- Houston Methodist (Houston, TX)
- …with government regulations (ie Centers for Medicare and Medicaid ( CMS ), Internal Revenue Service (IRS), Federal Emergency Management Agency (FEMA), ... of taxes due. Interfaces across the organization with various system departments as well as government and business partner...**SERVICE ESSENTIAL FUNCTIONS** + Prepares and submits the annual Medicare cost report for each HM hospital and assists… more
- NTT America, Inc. (Plano, TX)
- …delivery design and requirements for successful performance + Stay updated on Medicare appeals regulations and guidelines from CMS collaborating with customers ... our team. NTT DATA is seeking to hire a ** Medicare Appeals Clinical Leader** to lead service delivery engagements...actions + Collaborate with health plans, clinical teams, utilization management , and other departments to address complex cases and… more
- Houston Methodist (Houston, TX)
- … cost reports, Federal Tax Returns Health and Human Services (HHS)/Centers for Medicare and Medicaid Services ( CMS ) reporting, Federal and State Charity ... teams to enable the effective and efficient completion of objectives. + Oversees management of and ensures development for staff to meet overall objectives in terms… more
- Elevance Health (Grand Prairie, TX)
- …Senior** is responsible for analyzing and validating healthcare encounter data submissions to CMS (Centers for Medicare & Medicaid Services). This role involves ... data quality management processes and procedures. + Provide support for CMS audits and other regulatory reporting requirements. + Develop and analyze business… more
- Houston Methodist (Houston, TX)
- …compliance; promotes continual improvement in compliance with standards, including ISO 9001 Quality Management System . + Conducts internal surveys across the HM ... for improvement; reports aggregate results and analysis through appropriate entity and system venues. + Coordinates content development and implementation of … more
- The Cigna Group (Fort Worth, TX)
- …insurance network filings to state Departments of Insurance (DOIs) and the Centers for Medicare & Medicaid Services ( CMS ). This position plays a key role in ... Provider Contracting, Provider Data** + **Knowledge of DOI or CMS guidelines, preferred** + **Project management experience,...life. We guide our customers through the health care system , empowering them with the information and insight they… more
- Centene Corporation (Austin, TX)
- …Needs Plans (D-SNPs) (compliance, product, and operations)._** + **_Experience in Medicare Managed Care and D-SNP compliance programs (audits, risk, regulations)._** ... skills._** + **_Solid audit experience_** + **_Hands-on experience with CMS Program Audits (including SNP) and training development._** + **_Ability… more