- Houston Methodist (Houston, TX)
- …of local and national coverage determinations + Comprehensive knowledge of Medicare , Medicaid, and Managed Care requirements + Comprehensive knowledge of community ... of Non-Coverage (HINN), Ambulatory Benefit Notice (ABN), Important Message from Medicare (IMM), Medicare Outpatient Observation Notice (MOON), and Condition… more
- Prime Therapeutics (Austin, TX)
- …in a manner that meets the specialized needs of the targeted population; for Medicare , is Centers for Medicare & Medicaid Services (CMS) compliance compliant + ... operations (eg workflow processes and case management) + Government programs ( Medicare ) knowledge **Preferred Qualifications** + Contact Center experience + Pharmacy… more
- Humana (Austin, TX)
- …**Preferred Qualifications** + Knowledge of the managed care industry including Medicare Advantage, Managed Medicaid and/or Commercial products, or other Medical ... management experience in a medical management review organization, such as Medicare Advantage, managed Medicaid, or Commercial health insurance. + Experience with… more
- CenterWell (Beaumont, TX)
- …Medicine or Geriatric Medicine preferred + Active and unrestricted DEA license + 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
- Molina Healthcare (San Antonio, 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
- Texas Health Resources (Arlington, TX)
- …Support & Case Review - Conduct additional reviews to assist departments handling Medicare , OIG, or non- Medicare denials. Provide expert analysis on coding, ... captures a patient's health status and clinical condition. Proficiency in researching Medicare , OIG, CMS, and other regulatory sources to interpret policies and… more
- Deloitte (Dallas, TX)
- …knowledge of the individual medical and small group markets + Experience with Medicare products, including Medicare Advantage or Medicare Supplement products ... for various enrollee types + Experience with reimbursement models - including value based care/ACO modeling + Knowledge of group insurance products including disability, long term care, etc. The wage range for this role takes into account the wide range of… more
- Prime Therapeutics (Austin, TX)
- …Supports new client implementations + Supports all lines of business (commercial/HIM, Medicare and Medicaid) + Other duties as assigned **Education & Experience** + ... or within a highly regulated industry, including experience with Medicare , Medicaid, and the Affordable Care Act (ACA) +...related area of study, such as Juris Doctor + Medicare Part D, Medicaid, and/or Affordable Care Act knowledge… more
- Molina Healthcare (San Antonio, TX)
- …DOFR, DME, capitation, Physician pricing is required. + Must have knowledge on Medicare payment methods + Experience on Hospital payment methodology & processing is ... essential + Understanding on hospital claims processing and configuration works + Medicare fee schedule knowledge is required + Medicaid and Duals experience is… more
- Humana (Corpus Christi, TX)
- …Auditor ensures clinical documentation meets CMS regulations, OASIS accuracy, and Medicare Conditions of Participation. This role audits Start of Care, ... quality experience, with strong knowledge of CMS Home Health regulations and Medicare Conditions of Participation. + Familiarity with OASIS requirements and home… more