- Texas Health Resources (Arlington, TX)
- …Staff, Physicians and other hospital disciplines as required/designated regarding Medicare , Medicaid and Commercial payer guidelines. + Reviews Medicare ... one day stays and conducts medical necessity internal audits (100% one day stays) Additional perks of being a Texas Health employee + Benefits include 401k, PTO, medical, dental, Paid Parental Leave, flex spending, tuition reimbursement, Student Loan… more
- Texas Health Resources (Fort Worth, TX)
- …aspects of each treatment session in accordance with departmental, JCAHO, Medicare , and other applicable regulatory guidelines. + Documents assessments of education ... patient understanding of education provided in accordance with departmental, JCAHO, Medicare , and other applicable regulatory guidelines. + Reports and documents… more
- Humana (Austin, TX)
- …reporting on progress, challenges, and achievements to management. + Partner with Medicare Risk Adjustment (MRA) and vendors to establish data feeds for STARs ... efforts are leading to a better quality of life for people with Medicare , Medicaid, families, individuals, military service personnel, and communities at large. … more
- Kelsey-Seybold Clinic (Webster, TX)
- …and is in-network with major insurance plans. KelseyCare Advantage, a Medicare Advantage plan offered to Houston-area beneficiaries and affiliated with ... achieved an overall rating of 5-out-of-5-stars as part of the Centers for Medicare and Medicaid CMS annual assessment for eight consecutive years, including 2024.… more
- Sedgwick (Dallas, TX)
- …limited to: subrogation, Second Injury Fund excess recoveries and Social Security and Medicare offsets. + Reports claims to the excess carrier; responds to requests ... principles including medical management practices and Social Security and Medicare application procedures as applicable to line-of-business. + Excellent oral… more
- Kestra Medical Technologies, Inc (Fort Worth, TX)
- …products regulated by the Federal Food and Drug Administration and under contract with Medicare . Kestra maintains a drug free workplace and testing is a condition of ... products regulated by the Federal Food and Drug Administration and under contract with Medicare . Kestra maintains a drug free workplace and testing is a condition of… more
- Cognizant (Austin, TX)
- …based on the review of clinical documentation in accordance with Medicare , Medicaid, and third-party guidelines. . Effectively document and log claims/appeals ... Reviews can be based on InterQual, Milliman Clinical Guidelines (MCG), Medicare guidelines, and health insurer specific guidelines. . Review retro-authorizations in… more
- TEKsystems (Dallas, TX)
- …and submit 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,… more
- HCA Healthcare (San Antonio, TX)
- …standards of care and meets the requirements or regulations of JCAHO, Medicare , Medicaid, and appropriate licensing or certified boards. The manager is responsible ... conditions of participation, requirements or regulation of the following: JCAHO, Medicare , Medicaid, Texas State Licensures and Certifications as requires. **What… more
- Prime Therapeutics (Austin, TX)
- …all provider and member materials and communications, and product ownership for Medicare and Medicaid formularies + Provide consultation and recommendations to the ... experience + Knowledge of the applicable line of business (eg, Medicare , Medicaid, Exchange, Commercial, Employer Group) Every employee must understand, comply… more