- Humana (Austin, TX)
- … management . + Utilization management experience in a medical management review organization, such as Medicare Advantage, managed Medicaid, or Commercial ... by other healthcare professionals are in agreement with national guidelines, CMS requirements, Humana policies, clinical standards, and (in some cases) contracts.… more
- Prime Healthcare (Weslaco, TX)
- …in the United States in the various areas we serve: + Centers For Medicare & Medicaid Services ( CMS ) Five-Star Quality Rated + LeapFrog Hospital Safety ... EXPERIENCE, TRAINING + Must be knowledgeable regarding the Health Information Management Department process and its application and evaluation of qualitative issues.… more
- Molina Healthcare (San Antonio, TX)
- **Job Description** **Job Summary** Molina Pharmacy Services/ Management staff work to ensure that Molina members, providers, and pharmacies have access to all ... members, providers, pharmacists, pharmacies, and technicians to meet departmental and CMS standards. + Enforce HIPAA compliance standards and regulations while… more
- Houston Methodist (Houston, TX)
- …with government regulations (ie Centers for Medicare and Medicaid ( CMS ), Internal Revenue Service (IRS), Federal Emergency Management Agency (FEMA), ... of taxes due. Interfaces across the organization with various system departments as well as government and business partner...**SERVICE ESSENTIAL FUNCTIONS** + Prepares and submits the annual Medicare cost report for each HM hospital and assists… more
- NTT America, Inc. (Plano, TX)
- …delivery design and requirements for successful performance + Stay updated on Medicare appeals regulations and guidelines from CMS collaborating with customers ... our team. NTT DATA is seeking to hire a ** Medicare Appeals Clinical Leader** to lead service delivery engagements...actions + Collaborate with health plans, clinical teams, utilization management , and other departments to address complex cases and… more
- Houston Methodist (Houston, TX)
- … cost reports, Federal Tax Returns Health and Human Services (HHS)/Centers for Medicare and Medicaid Services ( CMS ) reporting, Federal and State Charity ... teams to enable the effective and efficient completion of objectives. + Oversees management of and ensures development for staff to meet overall objectives in terms… more
- Centene Corporation (Austin, TX)
- …fresh perspective on workplace flexibility. **Position Purpose:** Promote increased Medicare Supplemental Benefit efficiency, service levels, and value by capturing, ... Develop, plan, lead, monitor, and own multiple, concurrent resultant Medicare Supplemental Benefits utilizing cross functional teams to deliver defined… more
- Houston Methodist (Houston, TX)
- …compliance; promotes continual improvement in compliance with standards, including ISO 9001 Quality Management System . + Conducts internal surveys across the HM ... for improvement; reports aggregate results and analysis through appropriate entity and system venues. + Coordinates content development and implementation of … more
- The Cigna Group (Fort Worth, TX)
- …insurance network filings to state Departments of Insurance (DOIs) and the Centers for Medicare & Medicaid Services ( CMS ). This position plays a key role in ... Provider Contracting, Provider Data** + **Knowledge of DOI or CMS guidelines, preferred** + **Project management experience,...life. We guide our customers through the health care system , empowering them with the information and insight they… more
- CVS Health (Austin, TX)
- …vendor) to identify and submit ICD codes that are submitted to the Centers for Medicare and Medicaid Services ( CMS ) for the purpose of risk adjustment processes ... compliance with internal policies and procedures as well as regulatory guidance from CMS , OIG or other Regulatory body. **Required Qualifications** + Minimum of 1… more