- Elevance Health (Houston, TX)
- … Medicare and Medicaid Services to transform federal health programs. The ** Audit and Reimbursement Senior** will support our Medicare Administrative Contract ... + Requires a BA/BS and a minimum of 8 years of audit /reimbursement or related Medicare experience; or any combination of education and experience which would… more
- Elevance Health (Houston, TX)
- …Requirements:** + Requires a BA/BS degree and a minimum of 5 years of audit /reimbursement or related Medicare experience; or any combination of education and ... ** Audit & Reimbursement III** **Location** : This role...Health's family of brands. We administer government contracts for Medicare and partner with the Centers for Medicare… more
- WelbeHealth (Austin, TX)
- …growth drivers + Assist with month-end close, quarterly financial reporting, financial audit , Medicare /Medicaid audits, and other PACE specific projects + Keep ... payment model, including ability to track and analyze revenue streams (eg Medicare , Medicaid, Part D) along with PACE rates and regulatory constructs **Job… more
- Humana (Austin, TX)
- …other sources of expertise. The Behavioral Health Medical Directors will learn Medicare , Medicare Advantage and Medicaid requirements, and will understand how ... participate in meetings involving care management, provider relations, quality of care, audit , grievance and appeal and policy review. The Behavioral Health Medical… more
- Houston Methodist (Katy, TX)
- …HB Epic AR management experience + Strong working knowledge of Facility Medicare (Part A) guidelines. + Problem solving thought leader with proven execution ... other areas according to department specifications. + Partners with Internal Audit , Business Practices, Health Information Management, Patient Access Services, and… more
- Molina Healthcare (Fort Worth, TX)
- …from regulatory agency through analysis and response to findings. * Organize audit submissions, interact directly with auditors for all lines of business as ... of internal corrective action plans (CAPs) for both internal and external audit findings via coordination of responses to assure appropriateness as it relates… more
- TEKsystems (Houston, TX)
- NOW HIRING FOR EXPERIENCED MEDICARE PROVIDER SERVICES REPS!! This is fully remote anywhere, but you must be able to work 8a-8pEST Monday-Friday including 1 Saturday ... is responsible for responding to all Department of Health audit calls on a consistent basis. + Acts as...and working remotely + Basic to intermediate knowledge of Medicare insurance + Familiarity with MS Office Applications (Outlook,… more
- Molina Healthcare (Fort Worth, TX)
- …durable fixes, and convert disciplined CTM management into Stars gains, audit readiness, and measurable member-experience improvements. You'll begin as a senior ... related field (advanced degree a plus). **Experience** * 7+ years managing Medicare CTM, appeals & grievances, or related compliance functions-hands-on with CMS CTM… more
- Molina Healthcare (Houston, TX)
- …Data Validation) team, assisting in the execution of CMS and internal audit activities. This position contributes to the development of chart retrieval chase ... gain exposure to end-to-end RADV workflows and contribute to meaningful audit readiness efforts. **Knowledge/Skills/Abilities** + Assist with the identification and… more
- Humana (Austin, TX)
- …expertise and passion for accuracy will make a meaningful impact. As the Nurse Audit Manager, you will spearhead audit and validation processes to ensure medical ... of all relevant coding. + Identifies the root cause analysis of audit findings and submits recommendations for appropriate change management. + Applies clinical… more