- Centene Corporation (San Antonio, TX)
- …and maintains member information and care management activities to ensure compliance with current state, federal, and third-party payer regulators + Provides ... assessments and care coordination of formal healthcare/behavioral services with adults Medicaid recipients (18 - 65) + Experience managing high volume caseloads… more
- Molina Healthcare (San Antonio, TX)
- …and supervision of daily functional operations to insure compliance to contract requirements. **Knowledge/Skills/Abilities** * Oversees budget responsibilities ... type management responsibility. 5 years progressive experience supporting a Medicaid ,.Medicare and Marketplace or large claims processing environment with… more
- Molina Healthcare (TX)
- …our Payment Integrity and Claims Operations teams in ensuring the accuracy and compliance of Coordination of Benefits (COB) claim pricing and processing. This role ... will focus on identifying, reviewing, and validating Medicaid secondary payments to ensure alignment with internal configuration rules and regulatory guidance. The… more
- Molina Healthcare (San Antonio, TX)
- …complex business challenges that impact cost containment and regulatory compliance . The position requires strong business judgment, cross-functional coordination, ... tasks and projects to ensure Centers for Medicare & Medicaid Services (CMS) and State regulatory requirements are met...that drive measurable improvement. + Partners with finance and compliance to develop business cases and support reporting that… more
- Providence (TX)
- …(AVP) of Financial Counseling, you will have focused accountability on regulatory compliance across the system. You will assume a pivotal role encompassing legal ... coordination, regulatory compliance , strategic decision-making, and leadership. The AVP is accountable...efficiency and effectiveness of Financial Assistance Programs and the Medicaid submission process for 51 Providence and Affiliate hospitals,… more
- HCA Healthcare (Mckinney, TX)
- …alert and comp census reports daily. Work the Medicare 72 hour and Medicaid 24 hour reports to identify Compliance overlapping accounts. Transfer charges ... charges to accounts. Communicates any charge related issues to Charge Master Manager /Analyst. SUPERVISOR: Practice Manager /Billing Manager DUTIES INCLUDE BUT… more
- Humana (Austin, TX)
- …other vendors. + Document all calls and requests. + Search for Medicare and Medicaid Guidelines. + Process all incoming fax/emails request for services the same day. ... in special projects as assigned by your Supervisor or Manager . **Use your skills to make an impact** **Required...to help people with Medicare, or both Medicare and Medicaid , achieve their best possible health and wellness through… more
- CenterWell (Austin, TX)
- …experience; + Prior clinical experience, managed care experience, DME, Florida Medicaid **OR** utilization management experience + Demonstrates Emotional Maturity + ... degree in a related field + Experience with Florida Medicaid + Experience with Physical Therapy, DME, Cardiac or...of home health services, and fourth largest pharmacy benefit manager , CenterWell is focused on whole-person health by addressing… more
- Aveanna Healthcare (Corpus Christi, TX)
- …Position Details Position: Clinical Supervisor (RN) $5,000 SIGN ON BONUS Clinical Case Manager Join a Company That Puts People First! Aveanna Healthcare is one of ... + Collaborate with the operations and business development team. + Ensure compliance with State, Federal, Local, and Aveanna policies and procedures. Qualifications… more
- Molina Healthcare (TX)
- …intervention initiatives including all lines of business (Medicare, Marketplace, Medicaid ). Executes health plan's member and community quality focused interventions ... to identify opportunities for improvement + Surfaces to the Manager and Director any gaps in processes that may...+ 1 year of experience in Medicare and in Medicaid managed care + Experience with data reporting, analysis,… more