- Sedgwick (Plano, TX)
- …limited to subrogation, Second Injury Fund excess recoveries and Social Security and Medicare offsets. + Reports claims to the excess carrier; responds to requests ... of directions in a professional and timely manner. + Communicates claim activity and processing with the claimant and the client; maintains professional client relationships. + Ensures claim files are properly documented and claims coding is correct. + Refers… more
- Kelsey-Seybold Clinic (TX)
- …handle member and provider calls for self-funded, fully insured and Medicare Commercial plans. **Job Title: Managed Care Representative II** **Location: Pearland ... Administrative Office** **Department:** **Member Provider Service** **Job Type: Full Time** **Salary Range: $42,697 - $52,744 (Pay is based on several factors including but not limited to education, work experience, certifications, etc.)** **Qualifications**… more
- Community Hospital Corporation (Plano, TX)
- …parties including but not limited to Uncompensated Care, Disproportionate Share ( Medicare and Medicaid), American Hospital Association (and state) annual reporting. ... Gathers and interprets statistical information within each department, maintaining and reporting productivity Hospital/Clinic wide. + Ability to communicate interdepartmentally, presenting complex topics professionally and ethically. Ability to provide… more
- UTMB Health (Galveston, TX)
- …SKILLS / ABILITIES:** * Knowledge of federal and state collection laws, Medicare , Medicaid, and other third-party pay or regulatory requirements. * Thorough ... knowledge of physician reimbursement and managed care contract issues. * Knowledge of Epic systems that support physicians billing services. * General knowledge of medical terminology and trends related to disease processes and technology available for… more
- CenterWell (Austin, TX)
- …+ Previous experience with pharmacy benefits management + Previous Commercial, Medicare and/or Medicaid experience + 3 or more years clinical experience ... in managed care + Ability to manage end-to-end-processes + Understand Humana's business processes, systems, tools, regulations and structure and how they interrelate to provide products and services that create value for Humana members + Previous management… more
- Molina Healthcare (Houston, TX)
- …+ Exposure to Databricks, Spark, or similar data platforms + Familiarity with Medicare Advantage or Medicaid programs + Awareness of CMS audit processes or ... healthcare compliance requirements **Ideal Candidate Attributes** + **Curious and Eager to Learn** : Interested in understanding healthcare data and willing to dig into unfamiliar topics. + **Team-Oriented** : Works well in a collaborative environment and… more
- BrightSpring Health Services (San Antonio, TX)
- …was established in the 1960s and began providing hospice-dedicated pharmacy serviceswhen the Medicare benefit took effect in the 1980s. Since then, we have grown to ... become one of the leading hospice pharmacies in the country. Our commitment to quality and superior service is unsurpassed in the industry. Our mission is to provide our patients, their caregivers and family members with the highest quality of care,reliability… more
- Jet Health (Denton, TX)
- …areas. About Us: Trio Home Health & Hospice / Jet Health, Inc. is a Medicare -certified home health & hospice care organization and one of the fastest growing home ... care companies. We are passionate about our employees and patients, providing exceptional care and fostering a supportive work environment. Requirements The Certified Nursing Assistant (CNA) will provide personal care and support services for patients under… more
- Texas Health Resources (Bedford, 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
- HCA Healthcare (San Antonio, TX)
- …and accepted internal (eg unit, department, and hospital) and external (eg TJC, Medicare , OSHA) standards. What qualifications you will need: + Associate Degree in ... Commission Top Performer on Key Quality Measures(R). Finally, by Medicare .gov as #1 in San Antonio and #6 in...hospital is 1 of only 102 hospitals to receive Medicare .gov's 5-star rating. Join our team to be part… more