- Houston Methodist (Katy, TX)
- …HB Epic AR management experience + Strong working knowledge of Facility Medicare (Part A) guidelines. + Problem solving thought leader with proven execution ... to ensure operational billing compliance with government/regulatory agencies and the Medicare and Medicaid programs. + Ensures optimization of timely cash… more
- Centene Corporation (Austin, TX)
- …planning and delivery of strategic programs and complex, large-scale enterprise-wide Medicare designs to execute defined requirements and meet company strategic ... executive level discussion. + End-to-end development, filing and execution of the Medicare Supplemental dental, vision and hearing benefits. Program Manager will own… more
- Elevance Health (Grand Prairie, TX)
- ** Medicare Risk Adjustment Advanced Analyst Senior** **Location:** This role requires associates to be in-office 1 - 2 days per week, fostering collaboration and ... dynamic and adaptable workplace. Alternate locations may be considered. The ** Medicare Risk Adjustment Advanced Analyst Senior** is responsible for creating… more
- Humana (Austin, TX)
- …clinical experience + Knowledge of the managed care industry including Medicare , Medicaid and/or Commercial products + Must be passionate about contributing ... efforts are leading to a better quality of life for people with Medicare , Medicaid, families, individuals, military service personnel, and communities at large. … more
- Molina Healthcare (Fort Worth, TX)
- …Enrollment activities (along with other Core Ops areas of responsibilities) within Medicare and Medicaid. Role is predicated on building relationships with vendors, ... the Service Level Agreements between the parties. **Job Duties** + Develops Medicare and Medicaid vendor strategies aligned with CMS and State regulations, including… more
- Molina Healthcare (Fort Worth, TX)
- …related field (advanced degree a plus). **Experience** * 7+ years managing Medicare CTM, appeals & grievances, or related compliance functions-hands-on with CMS CTM ... portal, SLA tracking, and program audits. * Deep knowledge of Medicare regulations affecting complaints, grievances, and member communications. * Exposure to… more
- Molina Healthcare (San Antonio, TX)
- …or special projects as required. + Must have experience working in Medicare + Must have experience analyzing claims. **Job Qualifications** **REQUIRED EDUCATION:** ... Associate's Degree and/or equivalent combination of education and Health Care related experience of 4+ years **REQUIRED EXPERIENCE/KNOWLEDGE, SKILLS & ABILITIES:** 4+ years experience in health care industry in related field **PREFERRED EDUCATION:** Bachelor's… more
- Guidehouse (San Antonio, TX)
- …TX office._** **Essential Job Functions** + Account Review + Appeals & Denials + Medicare /Medicaid + Insurance Follow-up + Customer Service + Billing + UB-04 & CMS ... 1500 + Complete all business-related requests and correspondence from patients and insurance companies. + Responsible for working on 40-70 Accounts Per Day + Complete all assigned projects in a timely manner. + Assist client and patients in all requested… more
- Molina Healthcare (TX)
- …speed to answer, and average hold time are compliant with Centers for Medicare and Medicaid Services (CMS) regulations. + Ensures that adequate staffing coverage is ... present at all times of operation. + Assists pharmacy leadership with monitoring and oversight of Molina's contracted Pharmacy Benefit Manager (PBM) for pharmacy contractually delegated functions. + Responsible for key performance indicators (KPI) reporting to… more
- Molina Healthcare (Austin, TX)
- …business analysis, task and workflow analysis. + Subject matter expert of Medicare and Healthcare enrollment 834 files. + Interpret customer business needs and ... translate them into application and operational requirements + Communicate and collaborate with external and internal customers to analyze and transform needs, goals and transforming in to functional requirements and delivering the appropriate artifacts as… more