- Molina Healthcare (TX)
- …We are seeking a highly skilled and forward-thinking Big Data Engineer to join our healthcare data team. This role encompasses the end-to-end design, development, and ... management of large-scale data systems tailored for healthcare analytics. The ideal candidate will be responsible for architecting and maintaining robust, scalable, and secure data pipelines that support critical decision-making across the organization. This… more
- UTMB Health (Galveston, TX)
- …and estimates and ensures UTMB compliance with Medicare and Medicaid regulations. **Scope:** Institutional **Responsibilities:** + Responsible for technical aspects, ... calculations and analyses of multiple areas of Medicare and Medicaid reimbursement components including, but not limited to, cost report preparation, audits,… more
- Texas Health Resources (Arlington, TX)
- This VP Government Reimbursement & Medicaid Supplemental Payments directs, administers and coordinates activities related to reimbursement from Third-Party ... through various supplemental payment programs. The VP Government Reimbursement Medicaid Payments has the following duties and responsibilities: + Responsible… more
- Humana (Austin, TX)
- …may include national clinical guidelines, CMS policies and determinations, Medicaid state contracts, clinical reference materials, internal teaching conferences, and ... Behavioral Health Medical Directors will learn Medicare, Medicare Advantage and Medicaid requirements, and will understand how to operationalize this knowledge in… more
- Molina Healthcare (San Antonio, TX)
- …Assists and executes tasks and projects to ensure Centers for Medicare & Medicaid Services (CMS) and State regulatory requirements are met for Pre-pay Edits, ... Care Organization (MCO) or health plan setting, including experience in Medicaid and/or Medicare, or equivalent combination of relevant education and experience… more
- Humana (Austin, TX)
- …ensure successful submission and reconciliation of encounter submissions to Medicaid /Medicare. Ensures encounter submissions meet or exceed all compliance standards ... and develops tools to enhance the encounter acceptance rate by Medicaid /Medicare. Looking for long-term improvements of encounter submission processes. Begins to… more
- Prime Therapeutics (Austin, TX)
- …management. Enforces teamwork across all internal departments, as well as with Medicaid Clients, and an in-depth understanding of all rebate programs, trends, and ... state laws and standards of practice which govern the Medicaid Drug Rebate Program. + Ensures compliance with each...Drug Rebate Program. + Ensures compliance with each State Medicaid contract. + Maintains rebate records in accordance with… more
- Molina Healthcare (TX)
- …and processing. This role will focus on identifying, reviewing, and validating Medicaid secondary payments to ensure alignment with internal configuration rules and ... adjudication, QNXT system navigation, and strong analytical acumen. Experience in Medicaid managed care is required, and a background in payment integrity-either… more
- Public Consulting Group (Austin, TX)
- …+ Investigate complaints, initiatives and data packages against North Carolina (NC) Medicaid providers and conduct desk and routine reviews of assigned providers to ... letters, appeal summaries, etc. using standard templates. Communicate with NC Medicaid providers to obtain documentation, provide education as needed, and to… more
- Humana (Austin, TX)
- …of the managed care industry including Medicare Advantage, Managed Medicaid and/or Commercial products, or other Medical management organizations, hospitals/ ... in a medical management review organization, such as Medicare Advantage, managed Medicaid , or Commercial health insurance. + Experience with national guidelines such… more
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