- Texas Health Resources (Bedford, TX)
- …assessment, plan of care, and re-certifications in accordance with departmental, TJC, Medicare , and other applicable regulatory guidelines . Documents all aspects of ... each treatment session in accordance with departmental, TJC, Medicare , and other applicable regulatory guidelines . Obtains physician signature on all plans care and… more
- Houston Methodist (Sugar Land, TX)
- …of timely disposition options to assure maximum benefits for patients and reimbursement for the hospital. + Collaborates with revenue cycle regarding any claim ... clinical review during the pre-bill, audit, or appeal process. + Secures reimbursement for hospital services by communicating medical information required by all… more
- Gentiva (Lubbock, TX)
- …new physicians and facilities, durable medical equipment (DME) pickup, Medicare patient eligibility, obtaining authorization and reauthorization as needed, ... practice, including industry standards, regulations, and best practices (ie, Medicare , Medicaid, JCAHO, ACHC), company policies/procedures, and understanding of… more
- Cognizant (Austin, TX)
- …requirements and seek clarification when gaps are identified. + Interpret paper contracts for reimbursement + Work side by side with client team to add PBPs. + ... cautionary reduction functionality. + QNXT SMEs with experience in Medicare Benefit. + Experience with items like Cost Share....Have worked with QCS. + Familiarity with Medicaid and Medicare programs are minimum requirements, as well as knowing… more
- Humana (Austin, TX)
- …preferably in the health care or insurance industry, and specifically in Medicare Advantage products + Exceptional leadership and management skills, and the ability ... **Preferred Qualifications:** + Master's Degree + Knowledge of the Medicare Advantage market, products, regulations, and compliance standards **Additional… more
- BeneLynk (San Antonio, TX)
- …vital aspects of the role will include making and fielding calls to help Medicare and Medicaid Managed Care Plan Members determine which benefit(s) best suit them ... be assisting with include Community Programs (transportation, meals, energy discounts), Medicare Savings Programs, Medicaid, and Veteran's coordination of care. Our… more
- Cognizant (Plano, TX)
- …requirements, and seek clarification when gaps are identified. . Interpret paper contracts for reimbursement . . Work side by side with the client team to add PBPs. . ... . Experience with cautionary reduction functionality. . QNXT SMEs with experience in Medicare Benefit. . Experience with items like Cost Share. . Experience with… more
- Houston Methodist (Houston, TX)
- …or insurance company providing utilization review services + Knowledge of Medicare , Medicaid, and Managed Care requirements + Progressive knowledge of community ... of utilization management, case management, performance improvement, and managed care reimbursement + Ability to work independently and exercise sound judgment in… more
- Centene Corporation (San Antonio, TX)
- …or equivalent experience. 2+ years of experience in Sales, Healthcare, Medicare , CMS Regulations and/or Management. Prior experience working with brokers/agents ... & Disability license. Bilingual candidates strongly preferred (English/Spanish) **For Medicare /Commercial Solutions:** Must have a valid driver's license. Travel: As… more
- Molina Healthcare (Houston, TX)
- …have issues or complaints (eg, problems with claims and encounter data, eligibility, reimbursement , and provider website). * Serves as a resource to support Plan's ... hospitals, integrated delivery systems, and ancillary providers with Medicaid and/or Medicare products * 5+ years previous managed healthcare experience. * Previous… more
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