- Molina Healthcare (Fort Worth, TX)
- …medical director, and quality improvement staff. + Facilitates conformance to Medicare , Medicaid, NCQA and other regulatory requirements. + Reviews quality referred ... restrictions to practice and free of sanctions from Medicaid or Medicare . **PREFERRED EDUCATION:** + Master's in Business Administration, Public Health, Healthcare… more
- ChenMed (Houston, TX)
- …understanding of the company's patient population, including the complexities of Medicare programs + Exceptional organizational skills with the ability to ... + An understanding of the company's patient population, including the complexities of Medicare programs + Detail-oriented with the ability to multi-task. + Able to… more
- Houston Methodist (Sugar Land, TX)
- …or insurance company providing utilization review services + Knowledge of Medicare , Medicaid, and Managed Care requirements + Progressive knowledge of community ... of Non-Coverage (HINN), Ambulatory Benefit Notice (ABN), Important Message from Medicare (IMM), Medicare Outpatient Observation Notice (MOON), and Condition… more
- Zelis (TX)
- …through our modeling systems, validating pricing accuracy across Medicare , Medicaid, and commercial reimbursement methodologies, and supporting client-facing ... manipulate, and audit claim data. + Evaluate pricing scenarios based on Medicare , Medicaid, and commercial reimbursement rules. + Apply working knowledge of CPT… more
- CenterWell (Alice, TX)
- …two to five years directly applicable experience preferred + Experience managing Medicare Advantage panel of patients with understanding of Best Practice in ... care environment in a value based relationship environment + Medicare Provider Number / Medicaid Provider Number + Knowledge...Provider Number / Medicaid Provider Number + Knowledge of Medicare guidelines and coverage + Knowledge of HEDIS quality… more
- TEKsystems (Dallas, TX)
- …Ensure timely and accurate billing of claims via electronic or paper to Medicare , Medicaid, and Commercial Insurances in accordance with policy using primarily Niko ... as needed basis. Additional Skills & Qualifications A comprehensive understanding of Medicare , Medicaid, and/or Commercial Insurance program rules as it pertains to… more
- TEKsystems (Dallas, TX)
- …and denials. The ideal candidate will have a strong understanding of Medicare , Medicaid, and Commercial Insurance billing, particularly in the DME/HME space. Key ... Responsibilities: + Submit claims via Niko Health and Salesforce to Medicare , Medicaid, and Commercial payers. + Post payments and denials from EOBs, ensuring… more
- Centene Corporation (San Antonio, TX)
- …or equivalent experience. 2+ years of experience in Sales, Healthcare, Medicare , CMS Regulations and/or Management. Prior experience working with brokers/agents ... & Disability license. Bilingual candidates strongly preferred (English/Spanish) **For Medicare /Commercial Solutions:** Must have a valid driver's license. Travel: As… more
- Gentiva (Lubbock, TX)
- …new physicians and facilities, durable medical equipment (DME) pickup, Medicare patient eligibility, obtaining authorization and reauthorization as needed, ... practice, including industry standards, regulations, and best practices (ie, Medicare , Medicaid, JCAHO, ACHC), company policies/procedures, and understanding of… more
- Molina Healthcare (Fort Worth, TX)
- …achieve operational goals and executes tasks and projects to ensure Centers for Medicare & Medicaid Services (CMS) and State regulatory requirements are met for ... and experience. + At least 3 years of Experience with Medicaid and/or Medicare . + Proven experience owning operational projects from concept to execution, especially… more