- TEKsystems (Dallas, TX)
- …enrollment and re-enrollment applications for healthcare providers to Medicare, Medicaid , and commercial insurance plans. Maintain accurate and up-to-date provider ... enrollment, credentialing, or healthcare administration. Strong understanding of Medicare, Medicaid , and commercial insurance enrollment processes. Excellent organizational, communication,… more
- Molina Healthcare (Houston, TX)
- …with the standards and requirements established by the Centers for Medicare and Medicaid Services (CMS). **Essential Job Duties** * Enters denials and requests for ... Qualifications** * Customer/provider experience in a managed care organization ( Medicaid , Medicare, Marketplace and/or other government-sponsored program), or medical… more
- Molina Healthcare (Fort Worth, TX)
- …and requirements established by the Centers for Medicare and Medicaid **KNOWLEDGE/SKILLS/ABILITIES** + Responsible for the comprehensive research and resolution ... coordination of benefits, subrogation, and eligibility criteria. + Familiarity with Medicaid and Medicare claims denials and appeals processing, and knowledge of… more
- Molina Healthcare (Houston, TX)
- …and designated state systems, and reports results to accordingly. * Ensures Medicaid and waiver eligibility has been requested and received from state partners ... before transition/services are initiated. * Maintains confidentiality and complies with Health Insurance Portability and Accountability Act (HIPAA). * Attends internal meetings and regularly scheduled calls as assigned. Required Qualifications* At least 1 year… more
- Novo Nordisk (Houston, TX)
- …of the local payer market including Medicare, Commercial and Medicaid benefit designs, Payer Coverage, Prescription Coverage Requirements, Step Therapy, ... Coverage Gap, Copays, and Deductibles and the impact on customer decisions + Demonstrates understanding of territory customer groups and affiliations such as IPAs, Medical Groups, Health Systems, and Local Clinics and uses this to identify business… more
- Molina Healthcare (TX)
- …with the National Committee for Quality Assurance (NCQA), Centers for Medicare and Medicaid Services (CMS), state Medicaid entity requirements and all other ... groups. + Assists in preparation of documents for Centers for Medicare and Medicaid Services (CMS), state Medicaid , National Committee for Quality Assurance… more
- Humana (Austin, TX)
- …well as modeling financial impact of emerging therapeutics across Medicare and Medicaid LOBs + Researches and analyzes drugs and emerging therapeutics, including ... residency or similar pharmacy practice experience + Board Certified Pharmacotherapy Specialist (BCPS) + MBA, pharmacoeconomics or health outcomes training + An… more
- Molina Healthcare (Austin, TX)
- …(HCPC). * Experience demonstrating knowledge of Centers for Medicare and Medicaid Services (CMS) guidelines, MCG, InterQual or other medically appropriate clinical ... guidelines, Medicaid , Medicare, CHIP and Marketplace, applicable state regulatory requirements, including ability to easily access and interpret these guidelines. *… more
- Banner Health (TX)
- …with coding rules and regulations according to regulatory agencies for state Medicaid plans, Center for Medicare Services (CMS), Office of the Inspector General ... least one of the following: Certified Professional Coder (CPC), Certified Coding Specialist (CCS), Certified Coding Specialist - Physician (CCS-P), Certified… more
- Texas Tech University Health Sciences Center - El Paso (El Paso, TX)
- …while ensuring compliance with any relevant rules or regulations (including HIPAA, Medicaid , Medicare, and specific 3rd Party Payors) + Collaborate with appropriate ... compliance roles + Current CPC (Certified Profressional Coder), CCS (Certified Coding Specialist ), or CBCS (Certified Billing and Coding Specialist ) **Does this… more