- Molina Healthcare (Fort Worth, TX)
- …with the Service Level Agreements between the parties. **Job Duties** + Develops Medicare and Medicaid vendor strategies aligned with CMS and State regulations, ... **Job Summary** This position is responsible for the holistic management of the external vendor relationships for Claims and Enrollment activities (along with other… more
- BAYADA Home Health Care (Austin, TX)
- …for quality and adherence to policies and procedures. As a member of the Medicare Case Management (MCM) office, individuals in this role are expected to ... to the OASIS and ICD 10 coding while using the Medicare PDGM billing model and CMS guidelines. + Review and communicate OASIS edit recommendations to each… more
- Molina Healthcare (Fort Worth, TX)
- …** **Summary** Safeguard member trust and plan compliance by owning Molina's entire CMS Complaints Tracking Module (CTM) life cycle. As Director of CTM Oversight & ... issues, steer partners toward durable fixes, and convert disciplined CTM management into Stars gains, audit readiness, and measurable member-experience improvements.… more
- Humana (Austin, TX)
- …practice management + Utilization management experience in a medical management review organization, such as Medicare Advantage and managed Medicaid + ... by diverse resources which may include national clinical guidelines, CMS policies and determinations, Medicaid state contracts, clinical reference materials,… more
- Molina Healthcare (San Antonio, TX)
- …Summary** Responsible for leading, organizing and directing the activities of the Medicare Contracted Provider Post-Pay Claim Appeals and Disputes in accordance with ... the standards and requirements established by the Centers for Medicare and Medicaid. **Knowledge/Skills/Abilities** * Leads, organizes, and directs the activities of… more
- Centene Corporation (Austin, TX)
- …planning and delivery of strategic programs and complex, large-scale enterprise-wide Medicare designs to execute defined requirements and meet company strategic ... executive level discussion. + End-to-end development, filing and execution of the Medicare Supplemental dental, vision and hearing benefits. Program Manager will own… more
- Molina Healthcare (TX)
- …average speed to answer, and average hold time are compliant with Centers for Medicare and Medicaid Services ( CMS ) regulations. + Ensures that adequate staffing ... for review. + Assures that activities and processes are compliant with CMS and National Committee of Quality Assurance (NCQA) guidelines and Molina policies… more
- Guidehouse (Lewisville, TX)
- …from home._** **Essential Job Functions** + Account Review + Appeals & Denials + Medicare /Medicaid + Insurance Follow-up + Customer Service + Billing + UB-04 & ... CMS 1500 + Complete all business-related requests and correspondence...patients in all requested tasks. + Communicate to Guidehouse management areas of concern or areas of improvement. +… more
- Prime Therapeutics (Austin, TX)
- …Medicaid Services ( CMS ) compliance compliant + Utilize Prime's MTM process management system to record member specific information + Assess beneficiary ... all lines of business to support the Centers for Medicare & Medicaid Services ( CMS ) Star and... system operations (eg workflow processes and case management ) + Government programs ( Medicare ) knowledge **Preferred… more
- Centene Corporation (San Antonio, TX)
- …related field or equivalent experience. 2+ years of experience in Sales, Healthcare, Medicare , CMS Regulations and/or Management . Prior experience working ... of the book of business. + Participates in product training with Sales Management for Health Plan's commercial sales segments. + Assists with supporting Health… more