- CVS Health (Austin, TX)
- …to manage multiple health plan clients across multiple lines of business including Medicare , Medicaid, Exchange, and Commercial. This is a remote role, open to ... + Demonstrated understanding of CVSH clinical portfolio, marketplace segments dynamics ( Medicare , Medicaid, Exchange, and or Commercial) and industry trends +… more
- CenterWell (San Antonio, TX)
- …a part of our Tuberculosis (TB) screening program.** **Preferred Qualifications:** ** Medicare Provider Number** **Medicaid Provider Number** **Minimum of two to five ... years directly applicable experience preferred** **Experience managing Medicare Advantage panel of patients with understanding of Best Practice in coordinated care… more
- MD Anderson Cancer Center (Houston, TX)
- …the laboratory in which he/she is working complies with the CAP, JCAHO, FDA, Medicare , and CLIA regulations for accreditation. . Must be able to relate quality ... and that laboratory complies with the CAP, JCAHO, FDA, Medicare and CLIA regulations for accreditation. . Must be...Must assure compliance with standards of CAP, JCAHO, FDA, Medicare , and CLIA. . Must give theoretical guidance and… more
- Molina Healthcare (Dallas, TX)
- …in accordance with the standards and requirements established by the Centers for Medicare and Medicaid Services (CMS). M-F from 8am - 4:30pm EST will require ... (COB), subrogation and eligibility criteria. * Experience with Medicaid and Medicare claims denials and appeals processing, and knowledge of regulatory guidelines… more
- Molina Healthcare (Houston, TX)
- …according to the SIU's standards. Position must have thorough knowledge of Medicaid/ Medicare /Marketplace health coverage audit policies and be able to apply them in ... data from all types of healthcare providers that bill Medicaid/ Medicare /Marketplace. **KNOWLEDGE/SKILLS/ABILITIES** + Ensure investigators are managing their cases… more
- Molina Healthcare (Houston, TX)
- …Act** cases in accordance with the standards and requirements of Centers for Medicare and Medicaid Services (CMS). **Essential Job Duties** * Responsible for the ... (COB), subrogation and eligibility criteria. * Experience with Medicaid and Medicare claims denials and appeals processing, and knowledge of regulatory guidelines… more
- Molina Healthcare (Austin, TX)
- …Ownership** + Assists and executes tasks and projects to ensure Centers for Medicare & Medicaid Services (CMS) and State regulatory requirements are met for Pre-pay ... Organization (MCO) or health plan setting, including experience in Medicaid and/or Medicare , or equivalent combination of relevant education and experience + Proven… more
- Humana (Austin, TX)
- …of the responsibilities: + Engage with the producers and the Center for Medicare and Medicaid Services/Department of Insurance regulations specific to them if there ... proper entries to the general ledger. + Analyze and interpret Center for Medicare and Medicaid Services and Department of Insurance regulations to establish required… more
- Humana (Austin, TX)
- …+ 3+ years of SQL experience, preferably in SSMS. **Preferred Qualifications** + Medicare Advantage experience. + Experience with SQL and VBA highly preferred. + ... role is part of a team that owns the Medicare Advantage pricing methodology and supporting tools in the...to a better quality of life for people with Medicare , Medicaid, families, individuals, military service personnel, and communities… more
- Humana (Austin, TX)
- …approvals, as well as modeling financial impact of emerging therapeutics across Medicare and Medicaid LOBs + Researches and analyzes drugs and emerging therapeutics, ... + PharmD + Health Plan experience + Knowledge of Medicare as it relates to pharmacy + Six Sigma...to a better quality of life for people with Medicare , Medicaid, families, individuals, military service personnel, and communities… more