- 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
- Humana (Austin, TX)
- …Qualifications** + Bachelor's Degree + Minimum of 3 yrs health insurance claims or Medicare experience + Minimum 3 years of experience with Fraud, Waste, and Abuse ... continuously improving consumer experiences **Preferred Qualifications** + Proven knowledge in Medicare and Medicaid regulations + Certifications (BA, MBA, JD, MSN,… more
- Houston Methodist (Cypress, TX)
- …service line. This position works with the physicians and interprofessional healthcare team to facilitate and maintain compassionate, efficient quality care and ... stay are medically necessary, communicating clinical information to payors to ensure reimbursement . In addition to performing the duties of a CM, this position… more
- Houston Methodist (The Woodlands, TX)
- …accurate and complete clinical and payer information. Educates members of the patient's healthcare team on the appropriate access to and use of various levels of ... or insurance company providing utilization review services + Knowledge of Medicare , Medicaid, and Managed Care requirements + Progressive knowledge of community… more
- Banner Health (TX)
- …Demonstrates extensive knowledge of clinical documentation and its impact on reimbursement under Medicare Severity Adjusted System (MS-DRG),All Payer Group ... to apply your unique experience and expertise in support of a nationally-recognized healthcare leader. We offer stimulating and rewarding careers in a wide array of… more
- Houston Methodist (The Woodlands, TX)
- …are medically necessary and communicates clinical information to payors to ensure reimbursement . The CM PRN helps drive change by identifying areas where performance ... if needed, and informs management of the possible need for issuing Medicare Hospital Initiated Notice of Non-coverage. + Applies approved utilization criteria to… more
- Houston Methodist (The Woodlands, TX)
- …needs, as directed, and in collaboration with the clinical team. Follows payor/ reimbursement practices and regulations that may impact the patient's plan of care ... FUNCTIONS** + Assists the department in distributing required notices, including the Medicare Notice of Discharge to patients, securing signatures on the form from… more
- Gentiva (San Antonio, TX)
- …operations, ensuring compliance with state, federal, and accreditation standards (CMS, Medicare , Joint Commission, etc.) + Provide clinical oversight and ensure ... license in the state of employment (required) + Bachelor's degree in Nursing, Healthcare Administration, or related field (preferred) + 3+ years of experience in… more
- Wolters Kluwer (Coppell, TX)
- …machine-readable formats and SaaS-based solutions that power decision-making across the healthcare ecosystem. The Lead Product Manager translates customer and market ... and ensures that our solutions meet the needs of commercial healthcare customers-including payers, PBMs, digital health technology companies, and life sciences… more
- UTMB Health (Galveston, TX)
- …the development of reimbursement proposals. * Strong knowledge of healthcare reimbursement models, contract terms, and regulatory compliance. * Knowledgeable ... with commercial and government payers, including HMOs, PPOs, ACOs, and Medicaid/ Medicare Advantage plans. * Analyze reimbursement methodologies and contract… more