- Humana (Austin, TX)
- …efforts are leading to a better quality of life for people with Medicare , Medicaid , families, individuals, military service personnel, and communities at large. ... coding languages such as SAS and SQL + Prior Medicare Advantage or health insurance background + Additional skills...role provides a unique opportunity to get hands on Medicare Advantage experience in a rapidly growing area outside… more
- Houston Methodist (Houston, TX)
- …knowledge of local and national coverage determinations + Comprehensive knowledge of Medicare , Medicaid , and Managed Care requirements + Comprehensive knowledge ... of Non-Coverage (HINN), Ambulatory Benefit Notice (ABN), Important Message from Medicare (IMM), Medicare Outpatient Observation Notice (MOON), and Condition… more
- Prime Therapeutics (Austin, TX)
- …specialized needs of the targeted population; for Medicare , is Centers for Medicare & Medicaid Services (CMS) compliance compliant + Utilize Prime's MTM ... operations (eg workflow processes and case management) + Government programs ( Medicare ) knowledge **Preferred Qualifications** + Contact Center experience + Pharmacy… more
- Humana (Corpus Christi, TX)
- …efforts are leading to a better quality of life for people with Medicare , Medicaid , families, individuals, military service personnel, and communities at large. ... Auditor ensures clinical documentation meets CMS regulations, OASIS accuracy, and Medicare Conditions of Participation. This role audits Start of Care,… more
- Houston Methodist (Houston, TX)
- …+ Researches and keeps up-to-date with government regulations (ie Centers for Medicare and Medicaid (CMS), Internal Revenue Service (IRS), Federal Emergency ... requests for information. **SERVICE ESSENTIAL FUNCTIONS** + Prepares and submits the annual Medicare cost report for each HM hospital and assists in cost report… more
- Humana (Austin, TX)
- …efforts are leading to a better quality of life for people with Medicare , Medicaid , families, individuals, military service personnel, and communities at large. ... of Network Adequacy requirements and process optimization, primarily focusing on the Medicaid line of business, with a deep understanding of network build… more
- Humana (Austin, TX)
- …efforts are leading to a better quality of life for people with Medicare , Medicaid , families, individuals, military service personnel, and communities at large. ... investigations of reported, alleged or suspected fraud involving Florida's Medicaid Program. The Fraud and Waste Professional 2 coordinates investigation… more
- Centene Corporation (Austin, TX)
- …+ Develops, enhances and maintains provider relationship across all product lines ( Medicare , Medicaid , Ambetter). Supports the development and implementation of ... Providers and Systems), HOS (Health Outcomes Survey), CTMs (Complaints to Medicare ), Disenrollments, Appeals, and Grievances. + Collaborates with Provider Relations… more
- Humana (Austin, TX)
- …efforts are leading to a better quality of life for people with Medicare , Medicaid , families, individuals, military service personnel, and communities at large. ... Intelligence Engineer position will be supporting BI work for our Medicare organizations. **Senior Business Intelligence Engineer** : + Develops and maintains… more
- Walgreens (Dallas, TX)
- …billing and submission of claims to government- sponsored health care programs, including Medicare , Medicaid , and all other third-party payers, as well as the ... bodies and contracts with payers and pharmaceutical manufacturers (BOP, DEA, Medicare , accreditation bodies, compounding, FDA, etc.). + Complies with all federal… more