- Elevance Health (Grand Prairie, TX)
- …analyzing and validating healthcare encounter data submissions to CMS (Centers for Medicare & Medicaid Services). This role involves ensuring the accuracy and ... in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager , associates are required to work at an Elevance Health location at least… more
- CenterWell (Vernon, TX)
- …and be able to problem solve effectively. + Must possess knowledge of Medicare guidelines governing home health and hospice agencies. + Must have exceptional ... largest providers of home health services, and fourth largest pharmacy benefit manager , CenterWell is focused on whole-person health by addressing the physical,… more
- HCA Healthcare (Houston, TX)
- …+ You will reconcile daily front office collections + Work with your nurse manager and/or nurse coordinator to ensure daily schedule is streamlined + You will ... performed more than 100,000 endoscopic procedures. We are certifiedby the Centers for Medicare and Medicaid Services (CMS). Also, we have achieved the highest level… more
- Gentiva (Nacogdoches, TX)
- …relationships with supportive care team (eg, Social Worker and RN Care Manager ), as applicable, and involve team (internally and externally) when patient's care ... patient may be appropriate for home health or hospice care; Medicare /Medicaid regulations; and interdisciplinary process; value based and/or accountable organization… more
- CenterWell (San Antonio, TX)
- …of hands-on healthcare experience in a clinical setting, preferably within the Medicare population + Experience with Payor Portals + Proficient with Microsoft Office ... largest providers of home health services, and fourth largest pharmacy benefit manager , CenterWell is focused on whole-person health by addressing the physical,… more
- Humana (Austin, TX)
- …largest providers of home health services, and fourth largest pharmacy benefit manager , CenterWell is focused on whole-person health by addressing the physical, ... efforts are leading to a better quality of life for people with Medicare , Medicaid, families, individuals, military service personnel, and communities at large. … more
- ChenMed (Houston, TX)
- …mission-driven, primary care organization, is currently one of the most successful full-risk Medicare Advantage providers in the nation and has a vision to be ... the company. + Performs other duties as assigned and modified at manager 's discretion. **KNOWLEDGE, SKILLS & ABILITIES:** **Competencies for Success** + Availability… more
- Molina Healthcare (San Antonio, TX)
- …MCG, InterQual or other medically appropriate clinical guidelines, Medicaid, Medicare , CHIP and Marketplace, applicable State regulatory requirements, including the ... Clinical Coder + Certified Medical Audit Specialist + Certified Case Manager + Certified Professional Healthcare Management + Certified Professional in Healthcare… more
- Molina Healthcare (Fort Worth, TX)
- …that involve clinical HCS staff. Communicates findings to the Supervisor or Manager , HCS Department for resolution. + Maintains a minimal caseload as determined ... HCS Department staff workload for adherence to the Policies, Procedures, Guidelines, Medicare Model of Care, and deadlines. Assures oversight and direction of… more
- Humana (Austin, TX)
- …researching and resolving provider reimbursement inquiries + Experience with Optum Rate Manager + Experience with Optum WebStrat or PSI applications + Experience ... efforts are leading to a better quality of life for people with Medicare , Medicaid, families, individuals, military service personnel, and communities at large. … more