- Molina Healthcare (Austin, TX)
- …provide quality and cost-effective member care. The candidate must have Medicare Appeals and/or Utilization Management knowledge. Work hours are Monday-Friday ... 8:00am- 5:00pm PST. This position included rotating weekends and holidays is required. Remote position **Essential Job Duties** * Assesses services for members to ensure optimum outcomes, cost-effectiveness and compliance with all state/federal regulations and… more
- Molina Healthcare (Fort Worth, TX)
- …clinical leadership and quality improvement teams. * Facilitates conformance to Medicare , Medicaid, NCQA and other regulatory requirements. * Reviews quality ... referred issues, focused reviews and recommends corrective actions. * Conducts retrospective reviews of claims and appeals and resolves grievances related to medical quality of care. * Attends or chairs committees as required such as credentialing, Pharmacy… more
- Baylor Scott & White Health (Dallas, TX)
- …are credentialed, privileged, and billed as an independent provider, recognized by Medicare and Medicaid. The Advanced Practice Provider provides medical care based ... on the scope of practice set by the supervising physician. Surgical providers care for adult and pediatric patients. They specialize in General Surgery, Orthopedics, Neurosurgery, Otolaryngology, Cosmetic, Vascular, Trauma, Transplant, Urology, Plastics, or… more
- Molina Healthcare (TX)
- …to, phone, chat, email, and off phone work supporting our Medicaid, Medicare and/or Marketplace business. * Conduct varies surveys related to health assessments ... and member/provider satisfaction. * Accurately document pertinent details related to Member or Provider inquiries. * Ability to work regularly scheduled shifts within our hours of operation, where lunches and breaks are scheduled and work over-time and/or… more
- Moore County Hospital District (Dumas, TX)
- …and memos. Ability to read and write simple correspondence. Experience in Medicare and Medicaid billing preferred. EXPERIENCE REQUIREMENTS: 3 years of business ... operations experience preferably in the health care industry. more
- UTMB Health (League City, TX)
- …distributed and authorized deferments, + Registration including eligibility, demographics and Medicare and third party coverage, communicates any obstacle to access ... or authorization to patient, referral source, UTMB Physician and clinical staff appropriately, + Dispositions patient within designated timeline. + Specialty/other + All Medical Assistant Essential Job Functions, and + Proficient in multiple specialty… more
- Molina Healthcare (Austin, TX)
- …to improve financial performance. * Advanced understanding of Medicaid and Medicare programs or other health care plans. * Advanced analytical work ... experience within the health care industry (ie, hospital, network, ancillary, medical facility, health care vendor, commercial health insurance, large physician practice, managed care organization, etc.) * Advanced proficiency with retrieving specified… more
- Humana (Austin, TX)
- …efforts are leading to a better quality of life for people with Medicare , Medicaid, families, individuals, military service personnel, and communities at large. ... **Equal Opportunity Employer** It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic… more
- Molina Healthcare (TX)
- …analytics. + Strong understanding of healthcare environments, including **Medicaid, Medicare , and Marketplace** member and provider engagement models. + Demonstrated ... success in implementing **AI-driven contact center and digital engagement initiatives** , including **Lightico, biometric authentication, and digital ID solutions.** + Financial management experience overseeing budgets, vendor contracts, and technology… more
- Southwest Nursing Center (Fort Worth, TX)
- …and ensures that the Centralized Statement process is followed. + Manages Medicare ADRs and appeals per established procedure. + Other duties, responsibilities and ... activities may change or assigned at any time with or without notice. Southwest Nursing Center provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to… more