- Evolent (Austin, TX)
- …under current exclusion or sanction by any state or federal health care program , including Medicare or Medicaid , and is not identified as an "excluded ... medical necessity guidelines, as well as other requests when providers, clients, or state laws require specialty reviews to be completed by the subject matter… more
- Humana (Austin, TX)
- …contract requires US Citizenship + Successfully receive interim approval for government security clearance (NBIS - National Background Investigation Services) + HGB ... authorized to do work in Puerto Rico per our government contract. We are not able to hire candidates...care service experience or working knowledge of TRICARE ACD program . + Healthcare professional with a Bachelor's degree in… more
- Amergis (Fort Worth, TX)
- …cases, and collaborating with multidisciplinary teams to ensure compliance with state and federal guidelines. Assignment Details: + Location: Fort Worth Area, ... case manager for assigned evaluations + Maintain documentation for Medicaid billing and district systems + Participate in ARD...(if applicable) + Current health certificate (per contract or state regulation) + Must meet all federal, state… more
- UTMB Health (Galveston, TX)
- …Lead the development, negotiation, and management of contracts with commercial and government payers, including HMOs, PPOs, ACOs, and Medicaid /Medicare Advantage ... reimbursement, alignment with organizational goals, and compliance with federal and state regulations. This role will oversee payer relationships, evaluate financial… more
- Evolent (Austin, TX)
- …under current exclusion or sanction by any state or federal health care program , including Medicare or Medicaid , and is not identified as an "excluded ... necessity guidelines, as well as other imaging requests when providers, clients, or state laws require specialty reviews to be completed by the subject matter… more
- Evolent (Austin, TX)
- …under current exclusion or sanction by any state or federal health care program , including Medicare or Medicaid , and is not identified as an "excluded ... necessity guidelines, as well as other imaging requests when providers, clients, or state laws require specialty reviews to be completed by the subject matter… more
- Molina Healthcare (Dallas, TX)
- …of claims processing related to inpatient/outpatient facilities contracted with Medicare, Medicaid , and Marketplace government -sponsored programs . * Data ... claims projects. * Evaluates claims using standard principles and applicable state -specific regulations to identify claims processing errors. * Applies claims… more
- Highmark Health (Austin, TX)
- …deliver value to the Health Plan, and its beneficiaries enrolled in Risk Adjusted government programs such as Medicare Advantage (MA) and Affordable Care Act ... medical coding, clinical terminology and anatomy/physiology, Centers for Medicare and Medicaid Services (CMS) coding guidelines, and Risk Adjustment Data Validation… more
- Amergis (Fort Worth, TX)
- …managing cases, and supporting ARD meetings to ensure compliance with federal, state , and district guidelines. Caseload Details + Caseload Size: 50-70 students + ... case manager for assigned evaluations o Maintain documentation for Medicaid billing o Input evaluations, session notes, and progress...TEA and federal regulations + Must meet all federal, state , and local requirements + Must be at least… more
- Amergis (Killeen, TX)
- …+ Serve as case manager for assigned evaluations + Maintain documentation for Medicaid billing and district systems + Participate in ARD meetings, present assessment ... (if applicable) + Current health certificate (per contract or state regulation) + Must meet all federal, state...insurance + 401(k) savings plan + Awards and recognition programs *Benefit eligibility is dependent on employment status. About… more