- Molina Healthcare (Fort Worth, TX)
- …with the standards and requirements established by the Centers for Medicare and Medicaid **KNOWLEDGE/SKILLS/ABILITIES** + Responsible for the comprehensive research ... benefits, subrogation, and eligibility criteria. + Familiarity with Medicaid and Medicare claims denials and appeals processing, and knowledge of regulatory… more
- USAA (San Antonio, TX)
- …a keen focus on financial risks associated with health products, especially Medicare Supplement offerings. This position is essential for safeguarding the integrity ... leading all aspects of financial risk associated with Health products, particularly Medicare Supplement + US military experience through military service or a… more
- Humana (Austin, TX)
- …2+ years of actuarial experience in healthcare + SAS or other coding skills + Medicare experience + Familiarity with CMS Star Ratings Travel: While this is a remote ... 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 (Houston, 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
- CVS Health (Austin, TX)
- …Qualifications** + Pharmacist + 7-10 years work experience in healthcare + Medicare and/or Medicare -Medicaid Integrated Product Experience + Experience with Part ... D Coverage Determination, Appeals and Grievances and/or Formulary Administration regulatory requirements and audit management + Experience with Part C & D reporting requirements + 3+ years serving as project lead + Adept at problem solving and decision making… more
- Kelsey-Seybold Clinic (Houston, 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
- 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
- Houston Methodist (The Woodlands, TX)
- …if needed, and informs management of the possible need for issuing Medicare Hospital Initiated Notice of Non-coverage. + Applies approved utilization criteria to ... capacity to prioritize multiple tasks and role components + Knowledge of Medicare , Medicaid and Managed Care requirements + Comprehensive knowledge of community… more
- Kelsey-Seybold Clinic (Houston, 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
- Kelsey-Seybold Clinic (Houston, 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