- Molina Healthcare (Houston, TX)
- …+ At least five (5) years' experience working in a Managed Care Organization or health insurance company + Minimum of two (2) years' experience working on ... according to the SIU's standards. Position must have thorough knowledge of Medicaid/ Medicare /Marketplace health coverage audit policies and be able to apply… more
- Community Health Systems (Corsicana, TX)
- …diagnostic tests. + Verifies the medical necessity of scheduled tests for Medicare patients and ensures compliance with payer requirements. + Refers uninsured and ... assistance programs as appropriate. + Reviews and verifies personal and insurance information for pre-certification orders, including CPT and ICD codes, obtaining… more
- Humana (Austin, TX)
- …focused on continuously improving consumer experiences **Preferred Qualifications** + PharmD + Health Plan experience + Knowledge of Medicare as it relates ... part of our caring community and help us put health first** Be a part of an interactive team...well as modeling financial impact of emerging therapeutics across Medicare and Medicaid LOBs + Researches and analyzes drugs… more
- Houston Methodist (Houston, TX)
- …services following review of relevant medical documentation, medical guidelines, and insurance benefits and communicates information to payers in accordance with ... + Collaborates with the physician and all members of the interprofessional health care team to facilitate care and communication with payers, and external… more
- Humana (Austin, TX)
- **Become a part of our caring community and help us put health first** The Actuary, Analytics/Forecasting analyzes and forecasts financial, economic, and other data ... + 3+ years of SQL experience, preferably in SSMS. **Preferred Qualifications** + Medicare Advantage experience. + Experience with SQL and VBA highly preferred. +… more
- Humana (Austin, TX)
- **Become a part of our caring community and help us put health first** The Actuary, Analytics/Forecasting analyzes and forecasts financial, economic, and other data ... expert on the End Stage Renal Disease (ESRD) population for Humana's individual Medicare Advantage plans. This includes: + Owning and improving our ESRD claims… more
- Humana (Austin, TX)
- **Become a part of our caring community and help us put health first** The Actuarial Analyst 2, Analytics/Forecasting analyzes and forecasts financial, economic, and ... This role will support a few tools used within our Individual Medicare Advantage pricing and internal reporting process. This includes: + Helping make… more
- ChenMed (Houston, TX)
- …role works directly with our patient population and their families, insurance representatives and outside vendors, physicians, clinicians and other medical personnel ... consult tracking tool. + Follows up on all Home Health and DME orders to ensure patient receives services...of the company's patient population, including the complexities of Medicare programs + Exceptional organizational skills with the ability… more
- CenterWell (Corpus Christi, TX)
- **Become a part of our caring community and help us put health first** Humana's Primary Care Organization (PCO) is the largest and fastest growing value-based care, ... Practice professionals, Pharm D, Care Coach Nurses, Medical Assistants, Behavioral Health , Specialists, Quality Based Coders, Referral Coordinators and more. Our… more
- CenterWell (Austin, TX)
- …Home Health preferred + Previous experience in utilization management within Insurance industry a plus + Previous Medicare Advantage/ Medicare **Alert** ... **Become a part of our caring community and help us put health first** Conviva Care Solutions is seeking a RN who will collaborate with other health care givers… more