- Houston Methodist (Katy, TX)
- …Extensive knowledge of claims reimbursement and collection efforts for Managed Care, Medicare , Medicaid, Workers Comp, Commercial plans, etc.; knowledge of how to ... interpret a managed care contract, Medicare and Medicaid and Workers Compensation + Extensive knowledge of billing, collections, reimbursement, contractual… more
- Evolent (Austin, TX)
- …current exclusion or sanction by any state or federal health care program, including Medicare or Medicaid, and is not identified as an "excluded person" by the ... Human Services or the General Service Administration (GSA), or reprimanded or sanctioned by Medicare . + No history of a major disciplinary or legal action by a state… 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
- HCA Healthcare (San Antonio, TX)
- …guidelines, CMS/AHCA policies and regulations + Federal Register, Center for Medicare and Medicaid Services, American Hospital Association, Food and Drug ... Administration, Medicare Administrative Contractors and payer websites + Escalates problem accounts/processes/trends and report opportunities to supervisor for… 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
- Prime Therapeutics (Austin, TX)
- …Management organization, or within a highly regulated industry, including experience with Medicare , Medicaid, and the Affordable Care Act (ACA) + Must be eligible ... Advanced degree in related area of study, such as Juris Doctor + Medicare Part D, Medicaid, and/or Affordable Care Act knowledge and experience **Physical Demands**… more
- ChenMed (Houston, TX)
- …Understanding of the communities served by ChenMed, including the complexities of Medicare programs to patients in the healthcare marketplace + Ability to determine ... coordinator, referral coordinator in a clinical setting, preferably within the Medicare HMO population We're ChenMed and we're transforming healthcare for seniors… more
- Molina Healthcare (TX)
- …Opportunity for a Texas licensed RN to join Molina to work with our Medicare members in the San Antonio service delivery area; candidates should reside in Bexar ... will be given to those candidates with previous experience working with the Medicare population within a Managed Care Organization (MCO). Mileage is reimbursed as… more
- Apex Health Solutions (Houston, TX)
- …technicians) in all aspects of pharmacy operations and services including Medicare part D oversight, coverage determination and re-determination (appeal) process, ... experience or other work experience in an equivalent background such as Medicare Part D program. Certificates and Licenses: Current, unrestricted Certified Pharmacy… more
- CenterWell (Austin, TX)
- …quality and cost improvement for high-risk senior populations in full risk Medicare arrangements. This individual will help assess the value of each opportunity ... quality and value drivers in full risk care delivery, ideally in Medicare /seniors + Demonstrated ability to work collaboratively with clinical and operational… more