- 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
- HCA Healthcare (Austin, TX)
- …you will need:** + Two years of experience within a licensed and certified ( Medicare ) home health agency required + Competent in Federal ( Medicare ) and Local ... to providing patients with quality care during their recovery at home. We are Medicare certified. Our patients are under the supervision of a physician and our team… more
- HCA Healthcare (San Antonio, TX)
- …you will need:** Two years of experience within a licensed and certified ( Medicare ) home health agency requiredCompetent in Federal ( Medicare ) and Local ... to providing patients with quality care during their recovery at home. We are Medicare certified. Our patients are under the supervision of a physician and our team… more
- Molina Healthcare (Fort Worth, TX)
- …for Quality Assurance (NCQA)/Healthcare Effectiveness Data Information Set (HEDIS)/ Medicare STARS). * Excellent organizational and time-management skills. * ... Quality (CPHQ) or other health care or management certification. * Medicaid/ Medicare population experience. * Clinical experience. * Familiarity and experience with… more
- Centene Corporation (Austin, TX)
- …Providers and Systems), HOS (Health Outcomes Survey), CTMs (Complaints to Medicare ), Disenrollments, Appeals, and Grievances. + Collaborates with Provider Relations ... enhances and maintains provider relationship across all product lines ( Medicare , Medicaid, Ambetter). Supports the development and implementation of quality… more
- Molina Healthcare (Austin, TX)
- …as well as Reporting modules related to Quality/HEDIS for Medicaid, Marketplace and Medicare /MMP. + Analysis and reporting related to Managed care data like Medical ... tracking for at least one line of business among Medicaid, Marketplace and Medicare /MMP. + 3+ Years of experience in working with increasingly complex data problems… more
- Humana (Austin, TX)
- …Intelligence Engineer position will be supporting BI work for our Medicare organizations. **Senior Business Intelligence Engineer** : + Develops and maintains ... efforts are leading to a better quality of life for people with Medicare , Medicaid, families, individuals, military service personnel, and communities at large. … more
- Molina Healthcare (Houston, TX)
- …to determine if providers have sanctions/exclusions. * Reviews and processes daily alerts for Medicare Opt-Out reports to determine if any provider has opted out of ... Medicare . * Reviews and processes daily NPDB Continuous Query reports and takes appropriate action when new reports are found. **JOB QUALIFICATIONS** **Required… more
- Texas Tech University Health Sciences Center - El Paso (El Paso, TX)
- …to insurance companies in a timely manner. + Perform follow-up with Medicare , Medicaid, Medicaid, Managed Care, and Commercial insurance companies on unpaid ... **Preferred Qualifications:** + Associate's degree preferred. + Understanding of Medicare , Medicaid eligibility requirements and commercial insurance payer payment… more
- Kelsey-Seybold Clinic (Sugar Land, TX)
- …and is in-network with major insurance plans. KelseyCare Advantage, a Medicare Advantage plan offered to Houston-area beneficiaries and affiliated with ... achieved an overall rating of 5-out-of-5-stars as part of the Centers for Medicare and Medicaid CMS annual assessment for eight consecutive years, including 2024.… more