- Walgreens (Dallas, TX)
- …and submission of claims to government- sponsored health care programs, including Medicare , Medicaid, and all other third-party payers, as well as the facilitating ... bodies and contracts with payers and pharmaceutical manufacturers (BOP, DEA, Medicare , accreditation bodies, compounding, FDA, etc.). + Complies with all federal… more
- Kelsey-Seybold Clinic (Webster, TX)
- …insurers to offer value-based commercial health plans and is in-network with major insurance plans. KelseyCare Advantage, a Medicare Advantage plan offered to ... achieved an overall rating of 5-out-of-5-stars as part of the Centers for Medicare and Medicaid CMS annual assessment for eight consecutive years, including 2024.… more
- Cognizant (Austin, TX)
- …based on the review of clinical documentation in accordance with Medicare , Medicaid, and third-party guidelines. . Effectively document and log claims/appeals ... Reviews can be based on InterQual, Milliman Clinical Guidelines (MCG), Medicare guidelines, and health insurer specific guidelines. . Review retro-authorizations in… more
- Prime Therapeutics (Austin, TX)
- …all provider and member materials and communications, and product ownership for Medicare and Medicaid formularies + Provide consultation and recommendations to the ... to the plan + Provide clinical guidance and support for client's Health Insurance Marketplace business + Manage incoming requests for information from the plan… more
- CenterWell (Austin, TX)
- …and monitoring the Tele Sales Agents who are responsible for converting Medicare eligible callers to patients. The Care Delivery Call Quality Professional is ... quality auditing experience + Understanding of value-based primary care and/or Medicare Advantage + Familiarity with healthcare systems and patient satisfaction… more
- Aveanna Healthcare (Corpus Christi, TX)
- …in 2024 Comprehensive Benefits Package + Health, Dental, Vision, and Company-paid Life Insurance + Paid Holidays, Vacation Days, and Sick Days + Quarterly Bonus ... to infants, children, adolescents, and adults. Note: As an employer receiving Medicare and Medicaid funds, Aveanna employees must comply with all health-related… more
- Kelsey-Seybold Clinic (Sugar Land, TX)
- …insurers to offer value-based commercial health plans and is in-network with major insurance plans. KelseyCare Advantage, a Medicare Advantage plan offered to ... achieved an overall rating of 5-out-of-5-stars as part of the Centers for Medicare and Medicaid CMS annual assessment for eight consecutive years, including 2024.… more
- Molina Healthcare (Houston, TX)
- …facility members in custodial beds to return to the community. * Initiates referrals for Medicare and waiver process if member is not already Medicare or waiver ... are initiated. * Maintains confidentiality and complies with Health Insurance Portability and Accountability Act (HIPAA). * Attends internal meetings… more
- Molina Healthcare (Austin, TX)
- …performance is achieving desired results + Keep abreast of Medicaid and Medicare reforms and their impact on Molina Healthcare **JOB QUALIFICATIONS** **Required ... hospitals, network, ancillary, medical facilities, healthcare vendor, commercial health insurance company, large physician practices, managed care organization, etc.)… more
- Kelsey-Seybold Clinic (Houston, TX)
- …insurers to offer value-based commercial health plans and is in-network with major insurance plans. KelseyCare Advantage, a Medicare Advantage plan offered to ... achieved an overall rating of 5-out-of-5-stars as part of the Centers for Medicare and Medicaid CMS annual assessment for eight consecutive years, including 2024.… more