• Medicaid Pricing Actuary

    Humana (Austin, TX)
    …may be responsible for any combination of capitation rate review , drafting rate advocacy communications, actual-to-expected business analytics, forecasting ... efforts are leading to a better quality of life for people with Medicare , Medicaid, families, individuals, military service personnel, and communities at large. ​… more
    Humana (08/27/25)
    - Related Jobs
  • Case Manager Advanced - Transition in Care

    Houston Methodist (Houston, TX)
    …to department staff in communicating medical information required by external review entities, managed care contractors, insurers, fiscal intermediaries, state, and ... + Knowledge of community resources, health care financial and payer issues, Medicare , Medicaid and Managed Care requirements and eligibility for state, local and… more
    Houston Methodist (08/27/25)
    - Related Jobs
  • Location Director

    Aveanna Healthcare (Laredo, TX)
    …growth initiatives for the branch. + Leverage your business acumen to review financial reports and performance data, ensuring productivity and goal achievement. + ... while driving the future of home care excellence! As an employer accepting Medicare and Medicaid funds, employees must comply with all health-related requirements in… more
    Aveanna Healthcare (08/27/25)
    - Related Jobs
  • Senior Application Architect Contact Center…

    Humana (Austin, TX)
    …Humana values personal identity protection. Please be aware that applicants selected for leader review may be asked to provide a social security number if it is not ... efforts are leading to a better quality of life for people with Medicare , Medicaid, families, individuals, military service personnel, and communities at large. ​… more
    Humana (08/27/25)
    - Related Jobs
  • Medical Claims Processor - Remote

    Cognizant (Austin, TX)
    …with UB/institutional (CMS-1450) and/or professional (CMS 1500) claims + Knowledge of Medicare billing & payment and coverage guidelines and regulations + Experience ... in the analysis and processing of claims, utilization review /quality assurance procedures + Must be able to work with minimal supervision. + Creative thinker with… more
    Cognizant (08/26/25)
    - Related Jobs
  • Claims Processor (with Facets) - Healthcare Remote

    Cognizant (Austin, TX)
    …with UB/institutional (CMS-1450) and/or professional (CMS 1500) claims * Knowledge of Medicare / Medicaid payment and coverage guidelines and regulations. * 1 year of ... * Experience in the analysis and processing of claims for payments, utilization review /quality assurance procedures. * Must be able to work with minimal supervision.… more
    Cognizant (08/26/25)
    - Related Jobs
  • Sr Insurance Verifier-Full-time/Days

    Houston Methodist (Houston, TX)
    …knowledge of electronic health record software (EPIC preferred) + Knowledge of Medicare , Medicaid, and managed care reimbursement methodologies + Ability to manage ... to meet needs related to unanticipated patient volume + Ability to review clinical documentation for Medical Necessity and payer requirements + Working knowledge… more
    Houston Methodist (08/26/25)
    - Related Jobs
  • Social Worker MSW

    HCA Healthcare (Round Rock, TX)
    …+ You will maintain a thorough working knowledge of the rules of Medicare , Medicaid, and private payer regulations and processes. You will possess a thorough ... encourage you to apply for our Social Worker MSW opening. We promptly review all applications. Highly qualified candidates will be contacted for interviews. **Unlock… more
    HCA Healthcare (08/26/25)
    - Related Jobs
  • Clinical Research Nurse - Medicine - Pulmonary…

    Houston Methodist (Houston, TX)
    …data archiving. + Collaborates and prepares with Principal Investigator, Institutional Review Board (IRB) and regulatory documents for submission assuring compliance ... ESSENTIAL FUNCTIONS** + Assisting financial analyst in development of calendar and Medicare Cost Analysis. standard of care procedures vs. research and approving… more
    Houston Methodist (08/26/25)
    - Related Jobs
  • Hospice Nurse Practitioner

    Gentiva (San Angelo, TX)
    …per hospice policy and regulatory requirements. + Communicate clinical findings, review treatment plans, lab results, diagnostics, and medications with certifying ... Familiarity with LCD criteria and hospice documentation requirements + Knowledge of Medicare , Medicaid, ACHC, and other regulatory guidelines + Strong oral and… more
    Gentiva (08/25/25)
    - Related Jobs