- UTMB Health (Galveston, TX)
- …commercial and government payers, including HMOs, PPOs, ACOs, and Medicaid /Medicare Advantage plans. * Analyze reimbursement methodologies and contract performance ... performance indicators (KPIs) to evaluate contract outcomes and drive data [1]informed decisions. * Lead contract implementation efforts, including communication,… more
- Molina Healthcare (Fort Worth, TX)
- …(SIU) Investigator is responsible for supporting the prevention, detection, investigation, reporting , and when appropriate, recovery of money related to health care ... investigations, including but not limited to witness interviews, background checks, data analytics to identify outlier billing behavior, contract and program… more
- CVS Health (Austin, TX)
- …Tracking Database audits + Support audits out of QNXT and PRMS systems to support Medicaid SOC and SOX controls + Coordinate with applicable reporting areas as ... strategic thinking + Able to drive decisions based on data analysis + May be asked to support other...**Education** Bachelor's degree preferred / specialized training / relevant professional qualifications **Pay Range** The typical pay range for… more
- Molina Healthcare (Fort Worth, TX)
- …effective and efficient standards, protocols, processes, decision support systems, reporting and benchmarks that support ongoing improvements of clinical operations ... Social Worker (LCSW), Licensed Marriage and Family Therapist (LMFT), Licensed Professional Clinical Counselor (LPCC), or Licensed Master of Social Work (LMSW).… more
- Cardinal Health (Austin, TX)
- …investigations to resolve ethics and compliance issues. **Compliance Audit Manager** Reporting to the Compliance Director, this position supervises and manages ... compliance audits to determine organizational integrity of billing for professional (physician) services and/or hospital (technical) services. This position will… more
- Option Care Health (Sugar Land, TX)
- …compliance with Option Care Infusion Centers policies and procedures, professional standards and local, state, federal regulations/guidelines. + Identify urgent ... and emergent situations and intervene appropriately. + Support compliance reporting through rigorous clinical notes. + Responds promptly and appropriately to patient… more
- US Anesthesia Partners (Austin, TX)
- …processing, guidelines, laws, and EOBs. + Knowledge of managed care, Medicare, and Medicaid guidelines. + Data entry skills with high accuracy. + Knowledge ... trends to leadership. + Provides peer payer and system training support. + Gathers data and reports out in partnership with leadership. + All other duties assigned.… more
- Allied Universal (Mcallen, TX)
- …Desktop Inspectors and other PEO SVS operational staff for the execution and reporting of site visit inspection performance. + Professional attire, demeanor, and ... inspector will perform site visit inspection services for Medicare and Medicaid providers/suppliers in accordance with established requirements. The Inspector works… more
- Molina Healthcare (Dallas, TX)
- …+ Prior professional experience utilizing Microsoft Excel (eg, performing basic data analysis in excel and utilizing pivot tables and various functions such as ... troubleshooting. **Job Duties** + Research, review, and decipher state-specific Medicaid and Medicare reimbursement methodologies for providers, including hospitals… more
- Molina Healthcare (Dallas, TX)
- …of programs for members in accordance with prescribed quality standards; conducts data collection, reporting and monitoring for key performance measurement ... **Preferred Experience** 1 year of experience in Medicare and in Medicaid . **Preferred License, Certification, Association** + Certified Professional in… more