- Texas Health Resources (Arlington, TX)
- …assessment, plan of care, and re-certifications in accordance with departmental, TJC, Medicare , and other + applicable regulatory guidelines + Documents all aspects ... of each treatment session in accordance with departmental, TJC, Medicare , and other applicable regulatory guidelines + Obtains physician signature on all plans care… more
- NTT America, Inc. (Plano, TX)
- …Manager to join our team. NTT DATA is seeking to hire a ** Medicare Appeals Clinical Leader** to lead service delivery engagements and improve end-to-end delivery ... of Medicare Appeals. Desire experience specifically for processes for clinical...and requirements for successful performance + Stay updated on Medicare appeals regulations and guidelines from CMS collaborating with… more
- Houston Methodist (Houston, TX)
- …internal and external financial and governmental reporting requirements. Requirements include Medicare cost reports, Federal Tax Returns Health and Human Services ... (HHS)/Centers for Medicare and Medicaid Services (CMS) reporting, Federal and State...Report. + Directs the coordination, review and filing of Medicare and Medicaid cost reports and associated audits by… more
- Intermountain Health (Austin, TX)
- …+ Coordinates all aspects of provider enrollment with commercial and government ( Medicare and Medicaid) professional fee payer contracts for an entire market. ... aspects of provider enrollment with Intermountain Health's commercial and government ( Medicare and Medicaid) professional fee payer contracts for an entire market.… more
- Centene Corporation (Austin, TX)
- …Needs Plans (D-SNPs) (compliance, product, and operations)._** + **_Experience in Medicare Managed Care and D-SNP compliance programs (audits, risk, regulations)._** ... related field, or equivalent experience required + 5+ years experience in Medicare and/or D-SNP audit and compliance, including conducting risk assessments aligned… more
- Humana (Austin, TX)
- …best practices, and design clinical solutions for members who have Medicare and Medicaid. The Lead Product Manager partners across various multi-disciplinary ... our dual members - members that qualify for both Medicare and Medicaid. The Lead Product Manager sits in...to a better quality of life for people with Medicare , Medicaid, families, individuals, military service personnel, and communities… more
- Humana (Houston, TX)
- …preferably in the health care or insurance industry, and specifically in Medicare Advantage products + Exceptional leadership and management skills, and the ability ... **Preferred Qualifications:** + Master's Degree + Knowledge of the Medicare Advantage market, products, regulations, and compliance standards **Additional… more
- Humana (Austin, TX)
- …ensure successful submission and reconciliation of encounter submissions to Medicaid/ Medicare . Ensures encounter submissions meet or exceed all compliance standards ... and develops tools to enhance the encounter acceptance rate by Medicaid/ Medicare . Looks for long term improvements of encounter submission processes. Understands… more
- CVS Health (Austin, TX)
- …applicable) to ensure the ICD codes that are submitted to the Centers for Medicare and Medicaid Services (CMS) for the purpose of risk adjustment processes are ... International Classification of Disease (ICD) codes required. + Experience with Medicare and/or Commercial and/or Medicaid Risk Adjustment process and Hierarchical… more
- Molina Healthcare (San Antonio, 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