- 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
- CenterWell (Austin, TX)
- …and monitoring the Tele Sales Agents who are responsible for converting Medicare eligible callers to patients. The Care Delivery Call Quality Professional is ... quality auditing experience + Understanding of value-based primary care and/or Medicare Advantage + Familiarity with healthcare systems and patient satisfaction… more
- Humana (Austin, TX)
- …reviewing criteria to ensure appropriateness of care preferred + Previous Medicare experience a plus + Milliman MCG experience preferred **Additional Information** ... efforts are leading to a better quality of life for people with Medicare , Medicaid, families, individuals, military service personnel, and communities at large. … more
- CVS Health (Austin, TX)
- …**Position Summary** The Lead Director, Technology Product Management for Medicare Messaging Orchestration and STARs optimization will define strategic roadmaps, ... such as architects, tech-ops, security, etc. to ensure overall cohesion for the Medicare technology product line. You will develop and lead a team of product… more
- Humana (Austin, TX)
- …+ Accounting/Finance knowledge/experience + Advanced SQL or similar + Medicare /Medicaid experience + Data architecture/solution architecture experience + Project ... efforts are leading to a better quality of life for people with Medicare , Medicaid, families, individuals, military service personnel, and communities at large. … more
- Aveanna Healthcare (Corpus Christi, TX)
- …to infants, children, adolescents, and adults. Note: As an employer receiving Medicare and Medicaid funds, Aveanna employees must comply with all health-related ... of Aveanna's supportive and dynamic environment! As an employer accepting Medicare and Medicaid funds, employees must comply with all health-related requirements… more
- Allied Universal (Mcallen, TX)
- …Field Site inspector will perform site visit inspection services for Medicare and Medicaid providers/suppliers in accordance with established requirements. The ... Committee for Quality Assurance (NCQA) and The Joint Commission (TJC), Medicare Provider Enrollment, or other healthcare profession or facility credentialing, is… more