- Houston Methodist (Houston, TX)
- …and written communication. + Identifies denial trends and notifies supervisor and/or manager to prevent future denials and further delay in payments. Collaborates ... and provides support to other team members as advised by the manager and/or supervisor. **SERVICE ESSENTIAL FUNCTIONS** + Completes special projects to improve… more
- HCA Healthcare (Corpus Christi, TX)
- …leadership + Work with team members in billing, revenue integrity and/or the Medicare Service Center to resolve alerts/edits + Assign interim DRGs for in-house ... Reasons + Communicate coding revisions to the applicable party (eg, CIS, lead, manager , international log) + Periodically works with manager to review individual… more
- CenterWell (San Antonio, TX)
- …of hands-on healthcare experience in a clinical setting, preferably within the Medicare population + Experience with Payor Portals + Proficient with Microsoft Office ... of home health services, and fourth largest pharmacy benefit manager , CenterWell is focused on whole-person health by addressing...the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and… more
- Sysco (Houston, TX)
- …that traditionally require expertise around nutritional requirements, regulatory compliance , menu development, disaster planning, and Group Purchasing Organizations. ... experience **Licenses/Certification Preferred:** + Registered Dietitian License, Certified Dietary Manager (CDM), or Dietetic Technician, Registered (DTR) strongly preferred… more
- CenterWell (Austin, TX)
- …+ Previous experience with pharmacy benefits management + Previous Commercial, Medicare and/or Medicaid experience + Previous clinical experience in managed care ... of home health services, and fourth largest pharmacy benefit manager , CenterWell is focused on whole-person health by addressing...the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and… more
- CenterWell (Corpus Christi, TX)
- …* Knowledge of HEDIS measures and quality indicators * Experience managing Medicare Advantage panel of patients with understanding of Best Practice in coordinated ... of home health services, and fourth largest pharmacy benefit manager , CenterWell is focused on whole-person health by addressing...the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and… more
- Humana (Austin, TX)
- …largest providers of home health services, and fourth largest pharmacy benefit manager , CenterWell is focused on whole-person health by addressing the physical, ... to a better quality of life for people with Medicare , Medicaid, families, individuals, military service personnel, and communities...the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and… more
- Molina Healthcare (San Antonio, TX)
- …appropriate and correct clinical decisions for appeals outcomes within compliance standards. **KNOWLEDGE/SKILLS/ABILITIES** + The Clinical Appeals Nurse (RN) ... MCG, InterQual or other medically appropriate clinical guidelines, Medicaid, Medicare , CHIP and Marketplace, applicable State regulatory requirements, including the… more
- CenterWell (Corpus Christi, TX)
- …experience * Basic knowledge of Population Health Strategy * Familiarity with Medicare * Experience managing a budget of $500,000 **Work Schedule:** Full Time ... of home health services, and fourth largest pharmacy benefit manager , CenterWell is focused on whole-person health by addressing...the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and… more
- CenterWell (Fort Worth, TX)
- …indicators (KPIs), such patient experience via Net Promoter Score (NPS) and Medicare clinical quality via HEDIS, meeting local and organizational goals *Personally ... of home health services, and fourth largest pharmacy benefit manager , CenterWell is focused on whole-person health by addressing...the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and… more