- Evolent (Austin, TX)
- …Computer Proficiency + Not under current exclusion or sanction by any state or federal health care program, including Medicare or Medicaid, and is not identified ... make denial determinations as a specific case warrants. + Converses with medical office staff in order to obtain additional pertinent clinical history/information;… more
- Humana (Austin, TX)
- …Coding Educator is responsible for reviewing and analyzing internal data and medical records, as well as coordinating educational sessions with providers to enhance ... guidelines + Prior experience in provider education + Strong knowledge of medical record review + Understanding of billing, claims submission, and related processes… more
- CenterWell (Austin, TX)
- …collaborate with other health care givers in reviewing actual and proposed medical care and services against established CMS Coverage Guidelines/NCQA review criteria ... Previous experience in utilization management within Insurance industry + Previous Medicare Advantage/ Medicare /Medicaid Experience a plus + Current nursing… more
- WelbeHealth (Austin, TX)
- …ASC 606, revenue operations, control environment, and all required state and federal reporting requirements. Fulfillment of the role will also include driving ... efficiency in compliance reporting/revenue rate filings and leveraging insights to improve...improve financial performance and internal communication of state and federal plan adjustments. Additionally, this role is expected to… more
- Humana (Austin, TX)
- …skills to support the coordination, documentation and communication of medical services and/or benefit administration determinations. The Utilization Management ... a related field + Health Plan experience + Previous Medicare /Medicaid Experience a plus + Call center or triage...extends outside of work. Among our benefits, Humana provides medical , dental and vision benefits, 401(k) retirement savings plan,… more
- CenterWell (Austin, TX)
- …collaborate with other health care givers in reviewing actual and proposed medical care and services against established CMS Coverage Guidelines/NCQA review criteria ... + Previous experience in utilization management within Insurance industry + Previous Medicare Advantage/ Medicare + Current nursing experience in Hospital, SNF,… more
- Aveanna Healthcare (Corpus Christi, TX)
- …care. + Collaborate with the operations and business development team. + Ensure compliance with State, Federal , Local, and Aveanna policies and procedures. ... to infants, children, adolescents, and adults. Note: As an employer receiving Medicare and Medicaid funds, Aveanna employees must comply with all health-related… more
- CenterWell (Austin, TX)
- …quality and cost improvement for high-risk senior populations in full risk Medicare arrangements. This individual will help assess the value of each opportunity ... the Advisor will collaborate across functions (particularly Data, Technology, Analytics, Medical Economics, and Finance) to optimize strategies that address current… more
- Aveanna Healthcare (Fort Worth, TX)
- …implement, and evaluate the nursing service department's programs and activities, ensuring compliance with state, federal , and local regulations. + Coordinate ... to infants, children, adolescents, and/or adults. Note: As an employer receiving Medicare and Medicaid funds, Aveanna employees must comply with all health-related… more
- Humana (Austin, TX)
- …assessing, developing, and/or infusing policies and procedures with business operations. ** Compliance ** Understands the federal and state regulatory environment ... quarterly evolving practices report in collaboration with other UM associates and Medical Directors 10% 6. Create and maintain department communications in the form… more