- Elevance Health (Houston, TX)
- … Medicare Administrative Contract (MAC) with the federal government (The Centers for Medicare and Medicaid Services ( CMS ) division of the Department of Health ... member of Elevance Health's family of brands. We administer government contracts for Medicare and partner with the Centers for Medicare and Medicaid Services… more
- Humana (Austin, TX)
- …community and help us put health first** The Encounter Data Management Professional develops business processes to ensure successful submission and reconciliation ... of encounter submissions to Medicaid/ Medicare . Ensures encounter submissions meet or exceed all compliance standards via analysis of data, and develops tools to… more
- Humana (Austin, TX)
- … management . + Utilization management experience in a medical management review organization, such as Medicare Advantage, managed Medicaid, or Commercial ... by diverse resources which may include national clinical guidelines, CMS policies and determinations, clinical reference materials, internal teaching conferences,… more
- Molina Healthcare (TX)
- …Google or Adobe analytics (or similar) Google AdWords, Tag Manager systems, (Adobe or Google) CMS ( content management system ) Google Ads SEO, SEM, CRM ... and incorporate learnings to drive continuous improvements + Create promotional and content strategies to expand digital reach + Collaborate on developing content… more
- Humana (Austin, TX)
- …and help us put health first** The Medical Director relies on fundamentals of CMS Medicare Guidance on following and reviewing home health, SNF, DME, dual ... Medicare /Medicaid and Waiver requests. The Medical Director provides medical...other healthcare professionals are in agreement with national guidelines, CMS requirements, Humana policies, clinical standards, and (in some… more
- Houston Methodist (Houston, TX)
- …acute care indicators and criteria as approved by medical staff, payer guidelines, CMS , and other state agencies. In addition to performing the duties of the ... review functions through point of entry, observation progression of care management , concurrent review and denials reviews. Additionally, the URSN will prospectively… more
- Houston Methodist (The Woodlands, TX)
- …care indicators and criteria as approved by medical staff, payer guidelines, CMS , and other state agencies. This position prospectively or concurrently determines ... and local coverage determinations (LCDs & NCDs). This position collaborates with case management in the development and implementation of the plan of care and… more
- CVS Health (Austin, TX)
- …researching and resolving Medicare complaints received via the Centers for Medicaid and Medicare Services ( CMS ). In this role, you will manage a queue of ... Medicare knowledge/experience + Prior experience with complaints and/or Center for Medicare and Medicaid Services ( CMS ) + Medical/RX claim processing… more
- Providence (TX)
- …provide training, job aides and technical support for caregivers regarding Centers for Medicare and Medicaid Services ( CMS ) Medicare Secondary Payer ... more years of experience reporting third party liability settlements to Centers for Medicare and Medicaid Services ( CMS ), and federal and state licensing and/or… more
- Ensono (Houston, TX)
- …Interchange (EFI), Next Generation Desktop (NGD), Electronic File Interchange (EFI), and the CMS Identity Management System (IDM). **Why Ensono?** Ensono is ... and FIPS 140-2, as applicable. + Maintain and renew certifications required for system access and management , ensuring continued compliance and eligibility. +… more