- 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
- Molina Healthcare (TX)
- …to, phone, chat, email, and off phone work supporting our Medicaid, Medicare and/or Marketplace business. * Provide exemplary customer service to customers including ... members, co-workers, vendors, providers, government agencies, business partners, and general public * Assists agents with questions and escalated contact center communication channels and across multiple states and/or products. Recognizes trends and patterns… more
- Molina Healthcare (San Antonio, TX)
- …rate proposals. * Research, analyze, and consult Medicaid and Medicare reimbursement methodologies, evaluate the impact of reimbursement changes, educate/consult ... the health plans on the financial impact. * Work independently to support and validate Provider Network contracting and unit cost management activities through financial and network pricing modeling, analysis, and reporting * Ability to translate contract… more
- Molina Healthcare (Dallas, TX)
- …Health or Healthcare. **Preferred Experience** 1 year of experience in Medicare and in Medicaid. **Preferred License, Certification, Association** + Certified ... Professional in Health Quality (CPHQ) + Certified HEDIS Compliance Auditor (CHCA) To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing. Molina Healthcare offers a competitive… more
- Deloitte (Dallas, TX)
- …RN, Quality, DRG Validation and health IT preferred + Knowledge of Medicare reimbursement system and coding structures preferred + In-depth knowledge and experience ... in medical terminology, medical coding, and ICD-10-CM/PCS, IPPS payment system is a plus' + Experience in quality measurement, quality improvement, and value-based payment models + Proven applicable CPT and ICD-10 coding experience; APR-DRG, MS-DRG and HCC… 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
- 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
- Texas Health Resources (Fort Worth, TX)
- …elements are completed correctly, particularly the MSPQ, Important Message from Medicare (IMM) and medical necessity checking (ABN and Letter of Non-Coverage). ... * As a highly reliable organization stays up to date and complies with all applicable regulations with the operating systems, entity and system policies and procedures. * Maintains customer service and/or productivity guidelines set forth by applicable… 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