- BrightSpring Health Services (Harlingen, TX)
- …ensure compliance with Company policies and procedures, state licensure and regulations, Medicaid and Medicare standards, as well as state reimbursement ... regulations + Leading case conferences and other client-related meetings + Chairing committees as appropriate, safety, infection control, incident review, and human rights committees + Facilitating communication and serving as a liaison between and among… more
- University of Texas Rio Grande Valley (Mcallen, TX)
- …insurance eligibility and benefits through various payers, including commercial insurances, Medicaid , and Medicare . + Obtains the necessary prior authorizations, ... referrals, and other insurance documentation needed for all visits as required by the insurance carrier. + Performs all Time-of-Service collections including collecting copays, deductibles, and outstanding balances due on the account. + Educates the… more
- Caris Life Sciences (Irving, TX)
- …payor credentialing process and requirements, such as NCQA/state/federal standards, Medicaid , and Medicare . + Demonstrates proficient communication abilities, ... both orally and in writing, and strong interpersonal skills. + Exhibits a heightened level of awareness and attention to detail. + Demonstrates outstanding organizational and time management skills. + Demonstrate the ability to work autonomously while… more
- Sumitomo Pharma (Austin, TX)
- …+ Proficient knowledge and understanding of the payer landscape including commercial, Medicaid , and Medicare or relevant experience. + Demonstrates the ability ... to analyze complex data to develop strategic and actionable business plans to deliver sales results. + Candidates must have excellent communication & organizational skills and be proficient with technology platforms and business hardware/software. **Education… more
- Molina Healthcare (Dallas, TX)
- …and troubleshooting. **Job Duties** + Research, review, and decipher state-specific Medicaid and Medicare reimbursement methodologies for providers, including ... hospitals and facilities. + Developing expertise in complex groupers (APG, EAPG, APR-DRG, MS-DRG, etc.) utilized in reimbursement priced through PPS payment methodologies. + Support implementation of new pricers including: + Reviewing pricing software vendor… more
- NTT America, Inc. (Plano, TX)
- …Word and MS-Excel. Preferred Skills & Experiences: * Amisys or Xcelys * Medicaid and Medicare Claims processing experience * Ability to communicate ... (oral/written) effectively in a professional office setting * Effective troubleshooting where you can leverage your research, analysis and problem-solving abilities * Time management with the ability to cope in a complex, changing environment more
- HCA Healthcare (Jourdanton, TX)
- …has been nationally recognized as a Five-Star rated facility by the Centers for Medicaid and Medicare Services and by its grade A Leapfrog Hospital Safety ... score. The hospital is also a recipient of the Excellence in Patient Safety Across the Board Award and is designated as a Level IV trauma center and Ambulatory Services Sleep Center. Beyond offering Methodist-quality emergency care, our comprehensive services… more
- Molina Healthcare (Austin, TX)
- …observations into actions/interventions to improve financial performance. * Advanced understanding of Medicaid and Medicare programs or other health care plans. ... * Advanced analytical work experience within the health care industry (ie, hospital, network, ancillary, medical facility, health care vendor, commercial health insurance, large physician practice, managed care organization, etc.) * Advanced proficiency with… more
- Molina Healthcare (San Antonio, TX)
- …current and future contract rate proposals. * Research, analyze, and consult Medicaid and Medicare reimbursement methodologies, evaluate the impact of ... reimbursement changes, educate/consult the health plans on the financial impact. * Work independently to support and validate Provider Network contracting and unit cost management activities through financial and network pricing modeling, analysis, and… more
- Elevance Health (Grand Prairie, TX)
- …management. + Perform weekly clinical prior authorizations and coverage determinations for Medicaid and Medicare . + Participate in the pharmaceutical care ... management process through reviewing member profiles, recommending members for lock-in, case management or disease management. + Respond to and resolve issues related to member/provider complaints, claims processing issues and appeals. **Minimum… more